Provider Demographics
NPI:1134344773
Name:KREGER AILLS, NANCY KAYE (MSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KAYE
Last Name:KREGER AILLS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:KAYE
Other - Last Name:KREGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:3600 S DORT HWY
Mailing Address - Street 2:SUITE 44
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-744-3300
Mailing Address - Fax:810-744-1090
Practice Address - Street 1:3600 S DORT HWY
Practice Address - Street 2:SUITE 44
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-744-3300
Practice Address - Fax:810-744-1090
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010209031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB56322011Medicare ID - Type Unspecified