Provider Demographics
NPI:1457665176
Name:GREMP, MARY THERESA (PNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESA
Last Name:GREMP
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 S BUCKNER BLVD STE 139
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1704
Mailing Address - Country:US
Mailing Address - Phone:469-488-4400
Mailing Address - Fax:469-488-4401
Practice Address - Street 1:1401 S BUCKNER BLVD STE 139
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1704
Practice Address - Country:US
Practice Address - Phone:469-488-4400
Practice Address - Fax:469-488-4401
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705520363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics