Provider Demographics
NPI:1225286057
Name:GREGOIRE, ODELL ALEXANDRIA (LMT)
Entity Type:Individual
Prefix:
First Name:ODELL
Middle Name:ALEXANDRIA
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201149
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-1149
Mailing Address - Country:US
Mailing Address - Phone:907-317-1969
Mailing Address - Fax:907-222-7892
Practice Address - Street 1:5901 ARCTIC BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1677
Practice Address - Country:US
Practice Address - Phone:907-317-1969
Practice Address - Fax:907-222-7892
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK906835171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor