Provider Demographics
NPI:1619071099
Name:GREGSON, EVELYN MARY (NP)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:MARY
Last Name:GREGSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 OAKES AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4012
Mailing Address - Country:US
Mailing Address - Phone:508-765-9522
Mailing Address - Fax:508-764-7870
Practice Address - Street 1:38 OAKES AVE
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4012
Practice Address - Country:US
Practice Address - Phone:508-765-9522
Practice Address - Fax:508-764-7870
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111473363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA51977OtherFALLON COMMUNITY HEALTHCA
MANP1383Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MA51977OtherFALLON COMMUNITY HEALTHCA