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NPI Code Detail

MEDICARE: MS. KAREN E GRAY MSN, RN, CS, ONC

MEDICARE: MS. KAREN E GRAY MSN, RN, CS, ONC
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
1363LA2200XAdult Health Nurse Practitioner4704191904MI

General Provider Information

NPI Number : 1568466498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KAREN E GRAY MSN, RN, CS, ONC
Provider Business Mailing Address
First Line : 2929 BEMBRIDGE RD
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-2924
Country : US
Telephone Number : 248-721-5558
Fax Number :
Provider Business Practice Location Address
First Line : 16001 W 9 MILE RD
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48075-4818
Country : US
Telephone Number : 248-849-8807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 07/08/2007

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