Provider Demographics
NPI:1881826196
Name:GREGORY, LISA CAROL (RN, ANP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:GREGORY
Suffix:
Gender:F
Credentials:RN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0568
Mailing Address - Country:US
Mailing Address - Phone:765-521-1516
Mailing Address - Fax:765-599-3131
Practice Address - Street 1:1000 N 16TH ST
Practice Address - Street 2:SUITE # 240
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1461
Practice Address - Fax:765-599-3101
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003004A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000796329OtherANTHEM
IN200954520Medicaid
INP00762166OtherRAILROAD MEDICARE
IN200954520Medicaid