Provider Demographics
NPI:1548577224
Name:GRAY, LORENE ANN (RN, MSN, CNP)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:ANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN, MSN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 W SHADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1982
Mailing Address - Country:US
Mailing Address - Phone:651-492-3387
Mailing Address - Fax:
Practice Address - Street 1:6465 W SHADOW LAKE DR
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1982
Practice Address - Country:US
Practice Address - Phone:651-492-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3634363LG0600X
MNR103304-7364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology