Provider Demographics
NPI:1962837740
Name:GRAY, DEANNA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AYRAULT DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1927
Mailing Address - Country:US
Mailing Address - Phone:716-548-9998
Mailing Address - Fax:
Practice Address - Street 1:120 AYRAULT DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1927
Practice Address - Country:US
Practice Address - Phone:716-548-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY524217-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse