MEDICARE: JANET GRAY APRN

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	363L00000X	Nurse Practitioner	APN001526	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1780029405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET GRAY APRN

Provider Business Mailing Address
First Line	:	3041 E FLAMINGO RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7446
Country	:	US
Telephone Number	:	702-436-0835
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 E FLAMINGO RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7446
Country	:	US
Telephone Number	:	702-436-0835
Fax Number	:

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

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	11/12/2014

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