Provider Demographics
NPI:1508054776
Name:ALEXANDER, GRETCHEN LEATHERS (APRN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LEATHERS
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:LEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14185 N 3100 W
Mailing Address - Street 2:
Mailing Address - City:COLLINSTON
Mailing Address - State:UT
Mailing Address - Zip Code:84306-9749
Mailing Address - Country:US
Mailing Address - Phone:435-279-6755
Mailing Address - Fax:
Practice Address - Street 1:500 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-479-4105
Practice Address - Fax:801-584-2540
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292960-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health