Provider Demographics
NPI:1245730217
Name:GREGORY, JOANNA RICHARDSON (RN)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:RICHARDSON
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 1:1413 SHADYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-9247
Mailing Address - Country:US
Mailing Address - Phone:214-682-9064
Mailing Address - Fax:
Practice Address - Street 1:1413 SHADYBROOK LN
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9247
Practice Address - Country:US
Practice Address - Phone:214-682-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty