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NPI Code Detail

MEDICARE: MS. ANNETTE ELIZABETH GREGOIRE CNP

MEDICARE: MS. ANNETTE ELIZABETH GREGOIRE CNP
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
1363LA2200XAdult Health Nurse PractitionerR 075047-3MN
2364SA2200XAdult Health Clinical Nurse SpecialistR 075047-3MN

General Provider Information

NPI Number : 1396749222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANNETTE ELIZABETH GREGOIRE CNP
Provider Business Mailing Address
First Line : 1911 S LAKE IRVING DR SW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-8854
Country : US
Telephone Number : 218-759-0228
Fax Number :
Provider Business Practice Location Address
First Line : 500 E. VETERANS ST.
Second Line :
City : TOMAH
State : WI
Zip : 54660-3105
Country : US
Telephone Number : 608-372-3971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 09/24/2008

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