Provider Demographics
NPI:1659713865
Name:BRAY, CAITLIN T (CRNP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:T
Last Name:BRAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 SHADY GROVER RD.
Mailing Address - Street 2:140
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4015
Mailing Address - Country:US
Mailing Address - Phone:410-629-9471
Mailing Address - Fax:
Practice Address - Street 1:15825 SHADY GROVE RD STE 140
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4015
Practice Address - Country:US
Practice Address - Phone:410-629-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004505363L00000X
CA95007319363LF0000X
CT5707363LF0000X
HIAPRN-1873363LF0000X
FLAPRN11004406363LF0000X
MDR195733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner