Provider Demographics
NPI:1326383423
Name:REIBOLD, GRETCHEN (PA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:REIBOLD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BUCKWALTER PLACE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5023
Mailing Address - Country:US
Mailing Address - Phone:843-836-7101
Mailing Address - Fax:843-836-7112
Practice Address - Street 1:100 BUCKWALTER PLACE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5023
Practice Address - Country:US
Practice Address - Phone:843-836-7101
Practice Address - Fax:843-836-7112
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1866363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical