Healthcare Provider Details

I. General information

NPI: 1720914088
Provider Name (Legal Business Name): ELLIE GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 RESERVOIR ROAD NW
WASHINGTON DC
20057-1107
US

IV. Provider business mailing address

6199 S 206TH PLZ
ELKHORN NE
68022-4214
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-3118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number101796
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: