Provider Demographics
NPI:1205367042
Name:GREGG, ARANGERENE
Entity Type:Individual
Prefix:
First Name:ARANGERENE
Middle Name:
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 1:3024 ROUSE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8321
Mailing Address - Country:US
Mailing Address - Phone:910-682-7762
Mailing Address - Fax:910-758-9879
Practice Address - Street 1:3024 ROUSE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8321
Practice Address - Country:US
Practice Address - Phone:910-682-7762
Practice Address - Fax:910-758-9879
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4867251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care