Provider Demographics
NPI:1245603174
Name:GENATO, GRETCHEN DEBBIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:DEBBIE
Last Name:GENATO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 MICHELSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-0693
Mailing Address - Country:US
Mailing Address - Phone:855-229-6460
Mailing Address - Fax:
Practice Address - Street 1:3345 MICHELSON DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-0693
Practice Address - Country:US
Practice Address - Phone:855-229-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61116932363LF0000X
MT173480363LF0000X
CA95003351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily