Provider Demographics
NPI:1235480385
Name:WELLMAN, GRETCHEN RENEE (CO)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:RENEE
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LATOUCHE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4208
Mailing Address - Country:US
Mailing Address - Phone:907-561-1777
Mailing Address - Fax:907-561-2157
Practice Address - Street 1:3400 LATOUCHE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4208
Practice Address - Country:US
Practice Address - Phone:907-561-1777
Practice Address - Fax:907-561-2157
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO0012Medicaid
AKPO0012Medicaid