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NPI Code Detail

MEDICARE: LISA CAROL GREGORY RN, ANP-BC

MEDICARE: LISA CAROL GREGORY RN, ANP-BC
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 Practitioner71003004AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00762166OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000796329OTHERINANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881826196
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA CAROL GREGORY RN, ANP-BC
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2401 W UNIVERSITY AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47303-3428
Country : US
Telephone Number : 765-747-3111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2009
Last Update Date : 03/25/2026

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