Provider Demographics
NPI:1750650651
Name:GRAY, SHAWNA R (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 FARM ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-7875
Mailing Address - Country:US
Mailing Address - Phone:704-798-3324
Mailing Address - Fax:
Practice Address - Street 1:377 FARM ESTATES DR
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-5609
Practice Address - Country:US
Practice Address - Phone:704-798-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217603367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750650651Medicaid