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NPI Code Detail

MEDICARE: CAROL KOETHER GRAY CFNP

MEDICARE: CAROL KOETHER GRAY CFNP
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
1363L00000XNurse PractitionerLG0000193DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629007570
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL KOETHER GRAY CFNP
Provider Business Mailing Address
First Line : 179 W CHESTNUT HILL RD
Second Line : SUITE 1
City : NEWARK
State : DE
Zip : 19713-2210
Country : US
Telephone Number : 302-453-1343
Fax Number : 302-453-1654
Provider Business Practice Location Address
First Line : 179 W CHESTNUT HILL RD
Second Line : SUITE 1
City : NEWARK
State : DE
Zip : 19713-2210
Country : US
Telephone Number : 302-453-1343
Fax Number : 302-453-1654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2006
Last Update Date : 07/08/2007

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