Provider Demographics
NPI:1437322997
Name:ROTHFELDER, GRETCHEN ANNE
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANNE
Last Name:ROTHFELDER
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 1:27036 HART DR
Mailing Address - Street 2:
Mailing Address - City:WIND LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53185-1300
Mailing Address - Country:US
Mailing Address - Phone:262-895-6614
Mailing Address - Fax:
Practice Address - Street 1:27036 HART DR
Practice Address - Street 2:
Practice Address - City:WIND LAKE
Practice Address - State:WI
Practice Address - Zip Code:53185-1300
Practice Address - Country:US
Practice Address - Phone:262-895-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15696163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35043500Medicaid