Provider Demographics
NPI:1629390406
Name:GRAY, LYNDA (RN)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 TALL PINES LN
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-3346
Mailing Address - Country:US
Mailing Address - Phone:410-632-0391
Mailing Address - Fax:
Practice Address - Street 1:6040 PUBLIC LANDING ROAD
Practice Address - Street 2:WORCESTER COUNTY HEALTH DEPARTMENT
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863
Practice Address - Country:US
Practice Address - Phone:410-632-1100
Practice Address - Fax:410-632-0064
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR079486163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MD705371101Medicaid