Healthcare Provider Details

I. General information

NPI: 1184674723
Provider Name (Legal Business Name): JANICE A GREGORY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 W EDGERTON AVE
GREENFIELD WI
53220-4420
US

IV. Provider business mailing address

14675 W HONEY LN
NEW BERLIN WI
53151-2317
US

V. Phone/Fax

Practice location:
  • Phone: 414-421-8400
  • Fax:
Mailing address:
  • Phone: 262-827-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number351
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: