Provider Demographics
NPI:1043423957
Name:GREGORY, PAMELA RENEE (STNA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 ARLINGTON AVE
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2465
Mailing Address - Country:US
Mailing Address - Phone:419-382-1102
Mailing Address - Fax:
Practice Address - Street 1:3305 ARLINGTON AVE
Practice Address - Street 2:APARTMENT 2
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2465
Practice Address - Country:US
Practice Address - Phone:419-382-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5011027611005376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide