Individual
GEORGIA A GREMILLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Mailing address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2001028811
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429097215
—
MO
01
—
P00609537
RAILROAD MEDICARE
MO
Enumeration date
08/09/2005
Last updated
08/25/2008
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