Provider Demographics
NPI:1518078534
Name:GRAY, EILEEN H (CNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:H
Last Name:GRAY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4120
Mailing Address - Country:US
Mailing Address - Phone:401-333-3443
Mailing Address - Fax:
Practice Address - Street 1:195 COLLYER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1869
Practice Address - Country:US
Practice Address - Phone:401-276-2002
Practice Address - Fax:401-272-9299
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37328363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI31019OtherBLUE SHIELD
RI9004525Medicaid
RI007060748Medicare PIN
RI31019OtherBLUE SHIELD
RI509004525Medicare ID - Type Unspecified