Provider Demographics
NPI:1376785741
Name:GROSVELD, RAY ANTHONY (RN)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:ANTHONY
Last Name:GROSVELD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:670 9TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6249
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:2426 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3207
Practice Address - Country:US
Practice Address - Phone:707-442-4038
Practice Address - Fax:707-442-4039
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712627163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult