Provider Demographics
NPI:1154456390
Name:GREGORY, ARLENE J
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:J
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 1:160 E. NORTH FORK ROAD
Mailing Address - Street 2:P.O. BOX 234
Mailing Address - City:CENTENNIAL
Mailing Address - State:WY
Mailing Address - Zip Code:82055-0234
Mailing Address - Country:US
Mailing Address - Phone:307-745-9322
Mailing Address - Fax:307-745-9332
Practice Address - Street 1:160 E. NORTH FORK ROAD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:WY
Practice Address - Zip Code:82055-0234
Practice Address - Country:US
Practice Address - Phone:307-745-9322
Practice Address - Fax:307-745-9332
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-234171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor