Provider Demographics
NPI:1740636042
Name:BRAY, GRACE YU-HAESUNG (FNP-BC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:YU-HAESUNG
Last Name:BRAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984B LASKIN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3905
Mailing Address - Country:US
Mailing Address - Phone:757-395-6900
Mailing Address - Fax:
Practice Address - Street 1:984B LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3905
Practice Address - Country:US
Practice Address - Phone:757-395-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024173485OtherVIRGINIA STATE MEDICAL LICENSE
VA1740636042Medicaid