Provider Demographics
NPI:1952677536
Name:GREGORY, KARON NICHOLA (RN)
Entity Type:Individual
Prefix:
First Name:KARON
Middle Name:NICHOLA
Last Name:GREGORY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10133 124TH ST
Mailing Address - Street 2:QUEENS
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2101
Mailing Address - Country:US
Mailing Address - Phone:718-441-5493
Mailing Address - Fax:
Practice Address - Street 1:101-33 124 STREET
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:718-441-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489363372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider