Provider Demographics
NPI:1558419887
Name:GRAY, CATHERINE A (CNS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST SE
Mailing Address - Street 2:#405
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4917
Mailing Address - Country:US
Mailing Address - Phone:505-764-9535
Mailing Address - Fax:505-924-7336
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:#405
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-764-9535
Practice Address - Fax:505-924-7336
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22722364SM0705X
NMCNS00070364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP71466Medicare UPIN