Provider Demographics
NPI:1700990116
Name:DIGREGORIO, MARY FRANCES (MSW, APRN, BC, NP-C,)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANCES
Last Name:DIGREGORIO
Suffix:
Gender:F
Credentials:MSW, APRN, BC, NP-C,
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 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-739-4166
Mailing Address - Fax:314-739-2485
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:SUITE 700
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-739-4166
Practice Address - Fax:314-739-2485
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO072754363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427736608Medicaid
MO427736608Medicaid
MOP46253Medicare UPIN