Provider Demographics
NPI:1093851636
Name:GREGORY, MARY ELLEN (PERSONAL SUPPORTS)
Entity Type:Individual
Prefix:MISS
First Name:MARY ELLEN
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PERSONAL SUPPORTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WILKES ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5034
Mailing Address - Country:US
Mailing Address - Phone:207-649-7430
Mailing Address - Fax:
Practice Address - Street 1:33 WILKES ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5034
Practice Address - Country:US
Practice Address - Phone:207-649-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3001905171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor