Provider Demographics
NPI:1487692448
Name:GRAY, MARY HELEN (RN, NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HELEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2627
Mailing Address - Country:US
Mailing Address - Phone:952-738-4623
Mailing Address - Fax:952-738-4622
Practice Address - Street 1:5775 WAYZAYA BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-738-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 149240 0163W00000X
MN2006005436363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse