Provider Demographics
NPI:1407445679
Name:DEDEAUX, GREGORY HUGH (RN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:HUGH
Last Name:DEDEAUX
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13164 CATSKILL DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-4703
Mailing Address - Country:US
Mailing Address - Phone:228-257-0545
Mailing Address - Fax:
Practice Address - Street 1:13164 CATSKILL DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-4703
Practice Address - Country:US
Practice Address - Phone:228-257-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse