Provider Demographics
NPI:1083596282
Name:GREGOIRE, MIREILLE
Entity type:Individual
Prefix:
First Name:MIREILLE
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PARKWOLD DR E
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2152
Mailing Address - Country:US
Mailing Address - Phone:407-729-4042
Mailing Address - Fax:718-978-0032
Practice Address - Street 1:41 PARKWOLD DR E
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2152
Practice Address - Country:US
Practice Address - Phone:407-729-4042
Practice Address - Fax:718-978-0032
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse