Provider Demographics
NPI:1891450821
Name:GRAY, NATALIE CARMEN (LVN)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:CARMEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-6414
Mailing Address - Country:US
Mailing Address - Phone:214-542-1972
Mailing Address - Fax:
Practice Address - Street 1:332 MEADOW LN
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-6414
Practice Address - Country:US
Practice Address - Phone:214-542-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190243164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012420073210OtherALL INSURANCE