Provider Demographics
NPI:1518662212
Name:GRAY, ADRIA (RN, CHPN, EOL DOULA)
Entity Type:Individual
Prefix:
First Name:ADRIA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN, CHPN, EOL DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OREGON TRL
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5318
Mailing Address - Country:US
Mailing Address - Phone:845-800-1573
Mailing Address - Fax:
Practice Address - Street 1:800 STONY BROOK CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6526
Practice Address - Country:US
Practice Address - Phone:845-561-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645427163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice