Provider Demographics
NPI:1548937576
Name:GRAY, HEATHER B (FDN-P)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 FAIRPLAY DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3051
Mailing Address - Country:US
Mailing Address - Phone:970-690-0359
Mailing Address - Fax:
Practice Address - Street 1:2513 FAIRPLAY DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3051
Practice Address - Country:US
Practice Address - Phone:970-690-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA