MEDICARE: MS. MARLENE PEARLIE GREGG CRNA

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	367500000X	Certified Registered Nurse Anesthetist	1-037787	AL

General Provider Information

NPI Number	:	1760486658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLENE PEARLIE GREGG CRNA

Provider Business Mailing Address
First Line	:	4800 WHITESBURG DR SW # 30-212
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-1698
Country	:	US
Telephone Number	:	256-453-1228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 WHITESBURG DR SW # 30-212
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-1698
Country	:	US
Telephone Number	:	256-453-1228
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	05/29/2015

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