Provider Demographics
NPI:1831456888
Name:GRAY-BOLDEN, AYANNA NATASHA (CRNP)
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:NATASHA
Last Name:GRAY-BOLDEN
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 1:1 CENTURIAN DR STE 312
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2127
Mailing Address - Country:US
Mailing Address - Phone:302-319-5680
Mailing Address - Fax:302-319-5681
Practice Address - Street 1:1 CENTURIAN DR STE 312
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2127
Practice Address - Country:US
Practice Address - Phone:302-319-5680
Practice Address - Fax:302-319-5681
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily