Provider Demographics
NPI:1053287185
Name:GRAY, AMANDA BETHANY
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:BETHANY
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 CONROY LN APT S
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4157
Mailing Address - Country:US
Mailing Address - Phone:916-661-0911
Mailing Address - Fax:
Practice Address - Street 1:1140 CONROY LN APT S
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4157
Practice Address - Country:US
Practice Address - Phone:916-661-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula