Provider Demographics
NPI:1528394756
Name:GREGORY, JOANN LOUISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:LOUISE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 MARATHON-EDENTON RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107
Mailing Address - Country:US
Mailing Address - Phone:513-456-6218
Mailing Address - Fax:513-456-6218
Practice Address - Street 1:6241 MARATHON-EDENTON RD
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107
Practice Address - Country:US
Practice Address - Phone:513-456-6218
Practice Address - Fax:513-456-6218
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128001IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse