Provider Demographics
NPI:1275850729
Name:GRAY, DENICE L (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:DENICE
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 W MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2033
Mailing Address - Country:US
Mailing Address - Phone:414-810-3109
Mailing Address - Fax:
Practice Address - Street 1:1833 W MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2033
Practice Address - Country:US
Practice Address - Phone:414-810-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133540-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse