Provider Demographics
NPI:1588141840
Name:GRAY, CLARICE R (CNA)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 S PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3832
Mailing Address - Country:US
Mailing Address - Phone:773-619-3998
Mailing Address - Fax:
Practice Address - Street 1:10800 S PEORIA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3832
Practice Address - Country:US
Practice Address - Phone:773-619-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide