1710287511 NPI number — DEBORAH T. GRAY APRN

Table of content: DEBORAH T. GRAY APRN (NPI 1710287511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710287511 NPI number — DEBORAH T. GRAY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
DEBORAH
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710287511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 W.ESPLANADE AVE.
Provider Second Line Business Mailing Address:
MINUTECLINIC
Provider Business Mailing Address City Name:
KENNER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-467-8313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7725 EDWARD ST
Provider Second Line Business Practice Location Address:
MINUTECLINIC 820 W.ESPLANADE AVE. KENNER LA 70065
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70126-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-246-7107
Provider Business Practice Location Address Fax Number:
504-246-7107
Provider Enumeration Date:
10/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN053134-AP02492 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2009012139 . This is a "AMERICAN NURSES CREDENTIALING CENTER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2132237 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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