Provider Demographics
NPI:1154476794
Name:GRAY, MONICA (RN, BSN, MED)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN, BSN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 E VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1137
Mailing Address - Country:US
Mailing Address - Phone:480-484-5811
Mailing Address - Fax:
Practice Address - Street 1:6720 E CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3226
Practice Address - Country:US
Practice Address - Phone:480-484-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ163WS0200X163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626369Medicaid