Provider Demographics
NPI:1619472446
Name:GREGORY, RYENEYSA JACQUELYN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RYENEYSA
Middle Name:JACQUELYN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:RYENEYSA
Other - Middle Name:JACQUELYN
Other - Last Name:MACKALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:410 FOULK RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3802
Mailing Address - Country:US
Mailing Address - Phone:302-762-6675
Mailing Address - Fax:
Practice Address - Street 1:410 FOULK RD STE 200B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3802
Practice Address - Country:US
Practice Address - Phone:302-762-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-25
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily