Provider Demographics
NPI:1477653475
Name:GREGORY, OLYMPIA DENISE (CNM)
Entity Type:Individual
Prefix:MS
First Name:OLYMPIA
Middle Name:DENISE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:108 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2645
Mailing Address - Country:US
Mailing Address - Phone:860-859-3612
Mailing Address - Fax:860-859-3343
Practice Address - Street 1:108 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2645
Practice Address - Country:US
Practice Address - Phone:860-859-3612
Practice Address - Fax:860-859-3343
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000025367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400000025CT04OtherBLUE CROSS BLUE SHIELD
CT9468073OtherPHCS
CTP3755989OtherOXFORD
CT2731919OtherUNITED HEALTHCARE
CT6431476OtherCIGNA
CT004095677Medicaid
CT7774815OtherAETNA
CT2V5102OtherHEALTHNET