Provider Demographics
NPI:1528006095
Name:OLDS, GRETCHEN ELENE (RN, APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ELENE
Last Name:OLDS
Suffix:
Gender:F
Credentials:RN, APRN, NP-C
Other - Prefix:MS
Other - First Name:GRETCHEN
Other - Middle Name:ELENE
Other - Last Name:ELZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7400
Mailing Address - Fax:505-998-7740
Practice Address - Street 1:313 W COUNTRY CLUB RD STE 12
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5804
Practice Address - Country:US
Practice Address - Phone:575-627-5828
Practice Address - Fax:575-627-5835
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122840363LF0000X
GA122840363LF0000X
NM67156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM38626039Medicaid
GA50BBKJNMedicare UPIN