Provider Demographics
NPI:1407352933
Name:HERMANN, GRETCHEN KATHLEEN
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:KATHLEEN
Last Name:HERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 WALNUT ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3247
Mailing Address - Country:US
Mailing Address - Phone:716-207-7061
Mailing Address - Fax:
Practice Address - Street 1:713 WALNUT ST APT 2F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3247
Practice Address - Country:US
Practice Address - Phone:716-207-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program