Provider Demographics
NPI:1124545595
Name:GRAY, YVONNE B
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-677 HUI KELU ST # 7003
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4629
Mailing Address - Country:US
Mailing Address - Phone:808-683-9425
Mailing Address - Fax:
Practice Address - Street 1:47-677 HUI KELU ST # 7003
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4629
Practice Address - Country:US
Practice Address - Phone:808-683-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238515174N00000X
HIGE-210-564-9664-01374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN