MEDICARE: MRS. LOUANN GREGORY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	5617	SC

General Provider Information

NPI Number	:	1437582921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOUANN GREGORY

Provider Business Mailing Address
First Line	:	1999 SINGLEY ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5014
Country	:	US
Telephone Number	:	843-745-2030
Fax Number	:	843-745-2029

Provider Business Practice Location Address
First Line	:	1999 SINGLEY ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5014
Country	:	US
Telephone Number	:	843-745-2030
Fax Number	:	843-745-2029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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