Provider Demographics
NPI:1710369103
Name:GREGG, SUZANNE KAY (APRN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KAY
Last Name:GREGG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:NE
Mailing Address - Zip Code:68832-9809
Mailing Address - Country:US
Mailing Address - Phone:402-314-7172
Mailing Address - Fax:
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6960
Practice Address - Country:US
Practice Address - Phone:402-463-7711
Practice Address - Fax:402-461-5099
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health