Doctor Name: | HEATHER GREGORY |
NPI Number: | 1003136789 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 125.057912 |
Business Practice Address: | 836 W Wellington Ave Chicago, IL - 606575147 |
Business Phone Number: | 7732968248 |
Business Fax Number: | |
Mailing Address: | 3329 S Fellet Ct, LAKEWOOD |
State: | CO |
Postal Code: | 802275301 |
Phone Number: | 6198902437 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2010 |
NPI Last Update Date: | 06/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 125.057912 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |