Provider Demographics
NPI:1003808536
Name:GOICOECHEA, GRETCHEN (PA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:GOICOECHEA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-688-8000
Mailing Address - Fax:775-688-8031
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-688-8000
Practice Address - Fax:775-688-8031
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA632363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503015Medicaid
NV38708Medicare PIN
NVP25189Medicare UPIN