Provider Demographics
NPI:1568077824
Name:GREGORY, DANIELLE RENEE
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:RENEE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:D.
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:59 N HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2302
Mailing Address - Country:US
Mailing Address - Phone:330-261-3468
Mailing Address - Fax:
Practice Address - Street 1:59 N HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2302
Practice Address - Country:US
Practice Address - Phone:330-261-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01527423747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5005238OtherDODD
OH0152742Medicaid