Organization
DEPARTMENT OF VETERANS AFFAIRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA GREGORY RN (STAFF NURSE)
(859) 233-4511
Entity
Organization
Contact information
Practice address
209 PAULINE DR, BEREA, KY 40403-8889
(859) 233-4511
(859) 986-1289
Mailing address
209 PAULINE DR, BEREA, KY 40403-8889
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
1096474
KY
Other
Enumeration date
05/27/2011
Last updated
05/27/2011
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