Provider Demographics
NPI:1346614260
Name:GRAY, QUEENESTER B (FNP)
Entity Type:Individual
Prefix:
First Name:QUEENESTER
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 W TOUHY AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4619
Mailing Address - Country:US
Mailing Address - Phone:708-428-2996
Mailing Address - Fax:708-400-9078
Practice Address - Street 1:5940 W TOUHY AVE STE 370
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4619
Practice Address - Country:US
Practice Address - Phone:708-428-2996
Practice Address - Fax:708-400-9078
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily