Provider Demographics
NPI:1164001368
Name:GRAY, MAURA GRACE (RN)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:GRACE
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12229 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2985
Mailing Address - Country:US
Mailing Address - Phone:412-302-5553
Mailing Address - Fax:724-864-7316
Practice Address - Street 1:12229 ADAMS DR
Practice Address - Street 2:
Practice Address - City:N HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2985
Practice Address - Country:US
Practice Address - Phone:412-302-5553
Practice Address - Fax:724-864-7316
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN588615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse