Provider Demographics
NPI:1821150327
Name:GRAY, JUDITH MESTNIK (PA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MESTNIK
Last Name:GRAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:97 S 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2168
Mailing Address - Country:US
Mailing Address - Phone:906-228-9699
Mailing Address - Fax:906-228-0505
Practice Address - Street 1:104 MALTON RD
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2000
Practice Address - Country:US
Practice Address - Phone:906-228-4692
Practice Address - Fax:906-228-2830
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP23686Medicare UPIN