Provider Demographics
NPI:1437254661
Name:GREGORY, MARY MARGARET (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:GREGORY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202W BUENA VISTA RD 202
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5134
Mailing Address - Country:US
Mailing Address - Phone:812-429-0721
Mailing Address - Fax:812-429-1530
Practice Address - Street 1:1750 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4364
Practice Address - Country:US
Practice Address - Phone:812-485-2580
Practice Address - Fax:812-485-2590
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000491A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000234633OtherBCBS #
KY78006509Medicaid
IN200353310Medicaid
KY78006509Medicaid
IN500022431Medicare ID - Type UnspecifiedRR MCARE #
IN200353310Medicaid