Provider Demographics
NPI:1396396701
Name:SUMLIN-GRAY, KAREN
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:SUMLIN-GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9183 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1905
Mailing Address - Country:US
Mailing Address - Phone:414-517-1065
Mailing Address - Fax:855-515-7249
Practice Address - Street 1:9183 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1905
Practice Address - Country:US
Practice Address - Phone:414-357-8060
Practice Address - Fax:855-515-7249
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care