Provider Demographics
NPI:1366912701
Name:PORAY, ROZLYN GRACE (APRN, CRNA)
Entity type:Individual
Prefix:
First Name:ROZLYN
Middle Name:GRACE
Last Name:PORAY
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:ROZLYN
Other - Middle Name:GRACE
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4753 MALLARD LAKE CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9360
Mailing Address - Country:US
Mailing Address - Phone:207-416-9032
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4440
Practice Address - Country:US
Practice Address - Phone:203-416-9032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT138969163W00000X
TN31389367500000X
CT7982367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse