MEDICARE: NANCY MARIE GREGORY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	084059615RN	OR

General Provider Information

NPI Number	:	1033445820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY MARIE GREGORY RN

Provider Business Mailing Address
First Line	:	19021 INDIAN SPRINGS RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-8306
Country	:	US
Telephone Number	:	503-639-2106
Fax Number	:

Provider Business Practice Location Address
First Line	:	19021 INDIAN SPRINGS RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-8306
Country	:	US
Telephone Number	:	503-639-2106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	10/28/2009

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