Provider Demographics
NPI:1205610425
Name:GREGORY, ALISA ZENORA
Entity type:Individual
Prefix:MISS
First Name:ALISA
Middle Name:ZENORA
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-1502
Mailing Address - Country:US
Mailing Address - Phone:434-265-6363
Mailing Address - Fax:919-339-4836
Practice Address - Street 1:107 SEAMAN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3141
Practice Address - Country:US
Practice Address - Phone:434-265-6363
Practice Address - Fax:919-339-4836
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health