Provider Demographics
NPI:1871621433
Name:GRAY, CAROL LYNN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:GRAY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 RIVER BEND LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5103
Mailing Address - Country:US
Mailing Address - Phone:530-343-4132
Mailing Address - Fax:
Practice Address - Street 1:400 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0001
Practice Address - Country:US
Practice Address - Phone:530-898-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner