Provider Demographics
NPI:1013220961
Name:O'BRIEN, GRETCHEN (NP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:EHRENZELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GRETCHEN BOUCHER, NP
Mailing Address - Street 1:185 PILGRIM RD
Mailing Address - Street 2:BAKER 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5324
Mailing Address - Country:US
Mailing Address - Phone:617-667-8800
Mailing Address - Fax:
Practice Address - Street 1:148 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2505
Practice Address - Country:US
Practice Address - Phone:781-453-7750
Practice Address - Fax:781-453-7770
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN232134363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner