Provider Demographics
NPI:1508916222
Name:GREGORY, RENNA ADAIRE
Entity Type:Individual
Prefix:
First Name:RENNA
Middle Name:ADAIRE
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 1:3705 WEBB OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-8273
Mailing Address - Country:US
Mailing Address - Phone:336-469-1226
Mailing Address - Fax:
Practice Address - Street 1:3705 WEBB OLIVER RD
Practice Address - Street 2:
Practice Address - City:HAMPTONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27020-8273
Practice Address - Country:US
Practice Address - Phone:336-469-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3418374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide