Provider Demographics
NPI:1598233686
Name:GREGG, ANNIINA
Entity Type:Individual
Prefix:
First Name:ANNIINA
Middle Name:
Last Name:GREGG
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 1:3109 KENAI DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2540
Mailing Address - Country:US
Mailing Address - Phone:512-363-5178
Mailing Address - Fax:512-339-2664
Practice Address - Street 1:3109 KENAI DR STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2540
Practice Address - Country:US
Practice Address - Phone:512-363-5178
Practice Address - Fax:512-339-2664
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXACO1828171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXACO1828OtherACUPUNCTURE LICENSE