Provider Demographics
NPI:1114912078
Name:GOLAS, GRETCHEN (CRNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:GOLAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1205
Mailing Address - Country:US
Mailing Address - Phone:301-402-7951
Mailing Address - Fax:301-402-7951
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-402-7951
Practice Address - Fax:301-496-7157
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR061406363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics