Provider Demographics
NPI:1477647741
Name:FAUCETT, GRETCHEN T (CNM, APRN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:T
Last Name:FAUCETT
Suffix:
Gender:F
Credentials:CNM, APRN
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 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-1440
Mailing Address - Fax:801-408-1441
Practice Address - Street 1:370 E 9TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3184
Practice Address - Country:US
Practice Address - Phone:801-408-6100
Practice Address - Fax:801-408-6150
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT220295-4402367A00000X
UT2202954405207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005136106Medicare ID - Type Unspecified
UT000065167Medicare PIN
P42949Medicare UPIN