MEDICARE: NORMAN GRAYSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1396633509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMAN GRAYSON

Provider Business Mailing Address
First Line	:	1109 HOWARD ST APT 411
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102-2889
Country	:	US
Telephone Number	:	531-625-4116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 HOWARD ST APT 411
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102-2889
Country	:	US
Telephone Number	:	531-625-4116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/25/2025

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Directions to “ NORMAN GRAYSON ” Practice Location

Language	Start Address	Practice Location

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