Healthcare Provider Details

I. General information

NPI: 1558847491
Provider Name (Legal Business Name): VALERIE MARIE GREGORY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 ROLAND BLVD, STE. 2N
ST. LOUIS MO
63121-2931
US

IV. Provider business mailing address

3825 ROLAND BLVD, STE. 2N
ST. LOUIS MO
63121-2931
US

V. Phone/Fax

Practice location:
  • Phone: 314-337-7636
  • Fax: 314-833-3095
Mailing address:
  • Phone: 314-337-7636
  • Fax: 314-833-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2018021382
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number2018021382
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number2018021382
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018021382
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: