Provider Demographics
NPI:1770238719
Name:GRAY, OLGA V (FNP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:V
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:178 TURNERSBURG HWY
Mailing Address - Street 2:MINUTE CLINIC #5591
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625
Mailing Address - Country:US
Mailing Address - Phone:704-872-6355
Mailing Address - Fax:
Practice Address - Street 1:178 TURNERSBURG HWY
Practice Address - Street 2:MINUTE CLINIC #5591
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625
Practice Address - Country:US
Practice Address - Phone:704-885-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC264175OtherNORTH CAROLINA BOARD OF NURSING