Provider Demographics
NPI:1164157954
Name:GREGG, LORI A
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:GREGG
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 1:1952B HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-5354
Mailing Address - Country:US
Mailing Address - Phone:850-557-3595
Mailing Address - Fax:
Practice Address - Street 1:1952B HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-5354
Practice Address - Country:US
Practice Address - Phone:850-557-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula