Provider Demographics
NPI:1437582921
Name:GREGORY, LOUANN
Entity Type:Individual
Prefix:MRS
First Name:LOUANN
Middle Name:
Last Name:GREGORY
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 1:1999 SINGLEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5014
Mailing Address - Country:US
Mailing Address - Phone:843-745-2030
Mailing Address - Fax:843-745-2029
Practice Address - Street 1:1999 SINGLEY ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5014
Practice Address - Country:US
Practice Address - Phone:843-745-2030
Practice Address - Fax:843-745-2029
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse