Healthcare Provider Details

I. General information

NPI: 1508916222
Provider Name (Legal Business Name): RENNA ADAIRE GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 WEBB OLIVER RD
HAMPTONVILLE NC
27020-8273
US

IV. Provider business mailing address

3705 WEBB OLIVER RD
HAMPTONVILLE NC
27020-8273
US

V. Phone/Fax

Practice location:
  • Phone: 336-469-1226
  • Fax:
Mailing address:
  • Phone: 336-469-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC3418
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: