Provider Demographics
NPI:1982440590
Name:GREGORY, NADINE JANE (RD)
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:JANE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4193 ARIZONA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1712
Mailing Address - Country:US
Mailing Address - Phone:704-779-7586
Mailing Address - Fax:
Practice Address - Street 1:4193 ARIZONA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1712
Practice Address - Country:US
Practice Address - Phone:704-779-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133V00000X
MN5320133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered