Basic Information
Provider Information
NPI: 1841360179
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADRAY
FirstName: CAROL
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: NP
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Mailing Information
Address1: 3621 SOUTH STATE STREET
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 EAST MEDICAL CENTER DRIVE
Address2: 8TH FLOOR C.S. MOTT CHILDREN'S HOSPITAL
City: ANN ARBOR
State: MI
PostalCode: 481094254
CountryCode: US
TelephoneNumber: 7347634109
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/08/2006
LastUpdateDate: 01/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704192833MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LN0005XNP03321OHN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care

No ID Information.


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