Provider Demographics
NPI:1235133059
Name:SCHABER, GRETCHEN KARR (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:KARR
Last Name:SCHABER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86002-1907
Mailing Address - Country:US
Mailing Address - Phone:928-774-5533
Mailing Address - Fax:928-774-7366
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:STE 302
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1481
Practice Address - Country:US
Practice Address - Phone:928-214-0470
Practice Address - Fax:928-214-0477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN055253363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN055253OtherNURSE PRACTITIONER