Provider Demographics
NPI:1760781660
Name:GREY, RACHEL (APRN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1526
Mailing Address - Country:US
Mailing Address - Phone:860-229-1113
Mailing Address - Fax:860-229-2395
Practice Address - Street 1:621 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1526
Practice Address - Country:US
Practice Address - Phone:860-229-1113
Practice Address - Fax:860-229-2395
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004611363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner