Provider Demographics
NPI:1588674089
Name:GRAY, LAURA OWEN (MSN CNM RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:OWEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSN CNM RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:ROSEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28382-0768
Mailing Address - Country:US
Mailing Address - Phone:910-990-3902
Mailing Address - Fax:
Practice Address - Street 1:360 COUNTY COMPLEX RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4845
Practice Address - Country:US
Practice Address - Phone:910-592-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCNM376176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC376OtherNC CNM