Provider Demographics
NPI:1245777960
Name:MCCORD WOLBERT, GRETCHEN (CRNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MCCORD WOLBERT
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:PO BOX 11
Mailing Address - Street 2:411 MAPLE DRIVE
Mailing Address - City:LUCINDA
Mailing Address - State:PA
Mailing Address - Zip Code:16235-0011
Mailing Address - Country:US
Mailing Address - Phone:814-226-9091
Mailing Address - Fax:
Practice Address - Street 1:840 WOOD ST
Practice Address - Street 2:256 BECHT HALL
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1240
Practice Address - Country:US
Practice Address - Phone:814-393-2121
Practice Address - Fax:814-393-2035
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily