Healthcare Provider Details

I. General information

NPI: 1740711290
Provider Name (Legal Business Name): DONNA ROCHELLE GREGORY MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 59TH AVE SW
LAKEWOOD WA
98499-2858
US

IV. Provider business mailing address

9330 59TH AVE SW
LAKEWOOD WA
98499-2858
US

V. Phone/Fax

Practice location:
  • Phone: 253-620-5015
  • Fax: 253-620-5831
Mailing address:
  • Phone: 253-620-5015
  • Fax: 253-620-5831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: