Provider Demographics
NPI:1659392173
Name:GRAY, CHRISTINA (RN,MSN,ANP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN,MSN,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:AMMS, PC CREDENTIALING OFFICE
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-567-0455
Mailing Address - Fax:315-253-1795
Practice Address - Street 1:37 W GARDEN ST
Practice Address - Street 2:SUITE #201
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2662
Practice Address - Country:US
Practice Address - Phone:315-567-0777
Practice Address - Fax:315-702-8393
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301383-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01790427Medicaid
NYS24869Medicare PIN
NY01790427Medicaid