Provider Demographics
NPI:1972720670
Name:WRAY, ANDREA M (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:WRAY
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 1:305 E HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:STEELEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62288-1511
Mailing Address - Country:US
Mailing Address - Phone:618-965-9098
Mailing Address - Fax:
Practice Address - Street 1:#1 DR'S PARK
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6251
Practice Address - Country:US
Practice Address - Phone:618-242-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41298919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse