Provider Demographics
NPI:1033382700
Name:WOODWARD, GRETCHEN B (RN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:B
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:601 MARYS POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-2200
Mailing Address - Country:US
Mailing Address - Phone:508-295-3566
Mailing Address - Fax:508-295-3566
Practice Address - Street 1:20 W EMERSON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3137
Practice Address - Country:US
Practice Address - Phone:784-840-6659
Practice Address - Fax:307-459-6607
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN250917363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0714313Medicaid