Provider Demographics
NPI:1699004838
Name:GREGORY, YOLANDA MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:MARIE
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 1:555 1/2 E CENTRAL AVE
Mailing Address - Street 2:UPPER APT
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 1/2 E CENTRAL AVE
Practice Address - Street 2:UPPER APT
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1903
Practice Address - Country:US
Practice Address - Phone:419-729-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN114328164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse