Provider Demographics
NPI:1235403965
Name:GRAY, CHRISTY (RD, CD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10948 W 100 N
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9451
Mailing Address - Country:US
Mailing Address - Phone:219-879-2893
Mailing Address - Fax:
Practice Address - Street 1:2801 LEONARD DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7136
Practice Address - Country:US
Practice Address - Phone:219-476-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002112A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered