Provider Demographics
NPI:1447093174
Name:GRAY, ALIISA A
Entity type:Individual
Prefix:
First Name:ALIISA
Middle Name:A
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 1:76 GIFFORD LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2235
Mailing Address - Country:US
Mailing Address - Phone:978-764-8127
Mailing Address - Fax:
Practice Address - Street 1:76 GIFFORD LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2235
Practice Address - Country:US
Practice Address - Phone:197-876-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula