Provider Demographics
NPI:1255033049
Name:GRAY, ANNE (RN)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
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:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0880
Mailing Address - Country:US
Mailing Address - Phone:406-745-3525
Mailing Address - Fax:
Practice Address - Street 1:33116 US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:ELMO
Practice Address - State:MT
Practice Address - Zip Code:59915-7707
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-10367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse