Provider Demographics
NPI:1073726212
Name:MILLARD, GRETCHEN L (MS RD LD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:MILLARD
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7606 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1204
Mailing Address - Country:US
Mailing Address - Phone:541-667-3400
Mailing Address - Fax:541-667-3715
Practice Address - Street 1:610 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6601
Practice Address - Country:US
Practice Address - Phone:541-667-3400
Practice Address - Fax:541-667-3715
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered