Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 350386 | NY |
NPI | 1033586904 |
---|---|
Provider Name | Mrs. Katie Gregg |
First Address | Albany, NY 12208-3412 |
Second Address | Albany, NY 12208-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2015 |
Last Update Date | 27/08/2015 |