Provider Demographics
NPI:1174193916
Name:GRETCH, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:GRETCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 W FAIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4642
Mailing Address - Country:US
Mailing Address - Phone:308-398-0350
Mailing Address - Fax:308-398-0351
Practice Address - Street 1:1917 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4642
Practice Address - Country:US
Practice Address - Phone:308-398-0350
Practice Address - Fax:308-398-0351
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker