| NPI | 1073841011 |
|---|---|
| Former Name | TYNISE LA'SHAIE GRAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704240129) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704240129) |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2024-02-28 |