Provider Demographics
NPI:1376750547
Name:GREGORY, MARY EVA (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:EVA
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 MERCHANTS WALK
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-2863
Mailing Address - Country:US
Mailing Address - Phone:615-210-7620
Mailing Address - Fax:615-953-9544
Practice Address - Street 1:2602 MERCHANTS WALK
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-2863
Practice Address - Country:US
Practice Address - Phone:615-210-7620
Practice Address - Fax:615-953-9544
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000127133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education