Provider Demographics
NPI:1639822489
Name:GRAY, TYNAYA N (LPN)
Entity Type:Individual
Prefix:
First Name:TYNAYA
Middle Name:N
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OAKBROOK POINTE 700 COMMERCE DR SUITE 500
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-229-5210
Mailing Address - Fax:800-943-1859
Practice Address - Street 1:OAKBROOK POINTE 700 COMMERCE DR SUITE 500
Practice Address - Street 2:
Practice Address - City:OAKBROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-229-5210
Practice Address - Fax:800-943-1859
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043115425164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse