Provider Demographics
NPI:1538645957
Name:CHAN, GRETCHEN (FNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:MUSGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 UNIVERSITY OAKS STE 1260
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2437
Mailing Address - Country:US
Mailing Address - Phone:512-324-4780
Mailing Address - Fax:
Practice Address - Street 1:201 UNIVERSITY OAKS STE 1260
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2437
Practice Address - Country:US
Practice Address - Phone:512-324-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily