Provider Demographics
NPI:1265514277
Name:GRAY, ROBERTA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
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 1:13374 N 425 E
Mailing Address - Street 2:
Mailing Address - City:ROACHDALE
Mailing Address - State:IN
Mailing Address - Zip Code:46172
Mailing Address - Country:US
Mailing Address - Phone:765-522-1155
Mailing Address - Fax:
Practice Address - Street 1:HENDRICKS REGIONAL HEALTH PARTNERS IN CARE
Practice Address - Street 2:1000 E MAIN ST
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122
Practice Address - Country:US
Practice Address - Phone:317-745-9531
Practice Address - Fax:317-745-9534
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28095929A163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal