Individual
TAMMY GREGERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
5502 W BROADWAY AVE, CRYSTAL, MN 55428-3508
(763) 504-6500
(763) 504-6544
Mailing address
5502 W BROADWAY AVE, CRYSTAL, MN 55428-3508
(763) 504-6500
(763) 504-6544
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
945
MN
Other
Enumeration date
01/23/2007
Last updated
10/15/2009
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