Provider Demographics
NPI:1033189881
Name:GREGORY, KAREN JEAN (APRN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JEAN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1169
Mailing Address - Country:US
Mailing Address - Phone:860-621-8290
Mailing Address - Fax:
Practice Address - Street 1:200 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06089-9793
Practice Address - Country:US
Practice Address - Phone:860-843-8191
Practice Address - Fax:860-843-4939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002556363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health