Provider Demographics
NPI:1083776991
Name:GRAY, DEBORAH ANN (RN MSN AHNP FNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN MSN AHNP FNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BOSSERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1303 N ARLINGTON AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219
Mailing Address - Country:US
Mailing Address - Phone:317-353-0003
Mailing Address - Fax:317-353-0129
Practice Address - Street 1:1303 N ARLINGTON AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219
Practice Address - Country:US
Practice Address - Phone:317-353-0003
Practice Address - Fax:317-353-0129
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000561A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
71000561BOtherINDIANA CENTRAL
71000561BOtherINDIANA CENTRAL
P03313Medicare UPIN