Provider Demographics
NPI:1114970308
Name:GREGORIO, CHERYL ELAINE (PAC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ELAINE
Last Name:GREGORIO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ELAINE
Other - Last Name:COLE DREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:21ST MEDICAL GROUP/SGHQ (CREDENTIALS)
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1060
Mailing Address - Fax:719-556-9677
Practice Address - Street 1:559 VINCENT ST.
Practice Address - Street 2:
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1060
Practice Address - Fax:719-556-9677
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01706363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical