Basic Information
| Provider Information | |||||||||
| NPI: | 1710369103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGG | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | DONIPHAN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688329809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023147172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 S BURLINGTON AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689016960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024637711 | ||||||||
| FaxNumber: | 4024615099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2015 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 111823 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.