Provider Demographics
NPI:1386631687
Name:MCLAUGHLIN GRAY, CAROL (CRNA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MCLAUGHLIN GRAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10603 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2909
Mailing Address - Country:US
Mailing Address - Phone:315-896-2214
Mailing Address - Fax:315-896-2214
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5416
Practice Address - Country:US
Practice Address - Phone:315-724-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY448621367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R54896Medicare UPIN