Provider Demographics
NPI:1508366329
Name:METTLER, GREGORY (RN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:METTLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 COLONEL CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1301
Mailing Address - Country:US
Mailing Address - Phone:214-801-9178
Mailing Address - Fax:
Practice Address - Street 1:3213 COLONEL CIR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1301
Practice Address - Country:US
Practice Address - Phone:214-801-9178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX814963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse