Provider Demographics
NPI:1619634193
Name:GRAY, SUSAN BETH (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BETH
Last Name:GRAY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 HAESSLER AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-5014
Mailing Address - Country:US
Mailing Address - Phone:740-819-5362
Mailing Address - Fax:
Practice Address - Street 1:200 N MAYSVILLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6172
Practice Address - Country:US
Practice Address - Phone:740-455-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily