Individual
KATRINA GREGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
615 N MICHIGAN ST FL 1, SOUTH BEND, IN 46601-1033
(574) 647-1100
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
24886
SC
363LF0000X
Family Nurse Practitioner
Primary
71005182A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201259370
—
IN
01
—
261930017
MEDICARE PTAN
IN
Enumeration date
10/14/2014
Last updated
11/15/2022
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