Individual
COURTNEY MARIE GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
1501 RAEGAN WAY, SANTA ROSA, CA 95405-4526
(415) 640-8512
Mailing address
1501 RAEGAN WAY, SANTA ROSA, CA 95405-4526
(415) 640-8512
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
653350
CA
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L87781
CA
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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