Provider Demographics
NPI:1760486658
Name:GREGG, MARLENE PEARLIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:PEARLIE
Last Name:GREGG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 WHITESBURG DR SW # 30-212
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1698
Mailing Address - Country:US
Mailing Address - Phone:256-453-1228
Mailing Address - Fax:
Practice Address - Street 1:4800 WHITESBURG DR SW # 30-212
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1698
Practice Address - Country:US
Practice Address - Phone:256-453-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-037787367500000X
MEAA083172367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR32613Medicare UPIN
ALR32613Medicare UPIN
AL74137Medicare ID - Type Unspecified