Provider Demographics
NPI:1447672118
Name:GRAY, MELANIE LYNN
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
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 1:14160 SHADY BEACH TRL NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1364
Mailing Address - Country:US
Mailing Address - Phone:651-328-7699
Mailing Address - Fax:
Practice Address - Street 1:14160 SHADY BEACH TRL NE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1364
Practice Address - Country:US
Practice Address - Phone:651-328-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula