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NPI Code Detail

MEDICARE: MRS. PATRICIA ANN GREGORY CNA PPD CLC

MEDICARE: MRS. PATRICIA ANN GREGORY CNA PPD CLC
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
1174N00000XLactation Consultant (Non-RN)

General Provider Information

NPI Number : 1568752061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATRICIA ANN GREGORY CNA PPD CLC
Provider Business Mailing Address
First Line : 850 FLOYD ROAD EXT
Second Line :
City : SPARTANBURG
State : SC
Zip : 29307-1048
Country : US
Telephone Number : 864-415-1489
Fax Number :
Provider Business Practice Location Address
First Line : 850 FLOYD ROAD EXT
Second Line :
City : SPARTANBURG
State : SC
Zip : 29307-1048
Country : US
Telephone Number : 864-415-1489
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2011
Last Update Date : 04/18/2011

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