Gray, Tedra Duana

Gray, Tedra Duana is an individual health care provider with primary practice located at 1501 S California Ave , Chicago IL 60608-1732. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Gray, Tedra Duana can be contacted via phone (773) 257-2905.

Contact Information

Primary practice address
1501 S California Ave Chicago IL 60608-1732
Phone: (773) 257-2905
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 309-002757 Illinois

Profile Details

NPI number 1659358760
LBN Legal business name Gray, Tedra Duana
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 29th, 2005
Last updated Apr 26th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659358760 NPPES
Illinois MEDICAID 041323476-2

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