Provider Demographics
NPI:1447741798
Name:GREGOIRE, MARIE BERTUDE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:BERTUDE
Last Name:GREGOIRE
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 1:3501 W VINE ST STE 269
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4673
Mailing Address - Country:US
Mailing Address - Phone:407-785-2541
Mailing Address - Fax:407-785-2534
Practice Address - Street 1:3501 W VINE ST STE 269
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4673
Practice Address - Country:US
Practice Address - Phone:407-785-2541
Practice Address - Fax:407-785-2534
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233176376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL352404018OtherHOMEMAKER