Provider Demographics
NPI:1548388630
Name:GREGORY, MICHELLE YVETTE
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:YVETTE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 QUEENSBRIDGE CT APT L
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3137
Mailing Address - Country:US
Mailing Address - Phone:410-667-0263
Mailing Address - Fax:
Practice Address - Street 1:10 QUEENSBRIDGE CT APT L
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3137
Practice Address - Country:US
Practice Address - Phone:410-667-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00010527376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide