Provider Demographics
NPI:1629176052
Name:ALSIP VOLLBRECHT, GRETCHEN (ARNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:ALSIP VOLLBRECHT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1112
Mailing Address - Country:US
Mailing Address - Phone:503-788-7273
Mailing Address - Fax:503-788-7285
Practice Address - Street 1:107 E OAK AVE
Practice Address - Street 2:STE. 201
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1818
Practice Address - Country:US
Practice Address - Phone:855-913-8800
Practice Address - Fax:928-913-8801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201800607NP-PPOtherNP
WAIT40000933OtherINTERIM PERMIT
WARN00161098OtherSTATE RN LICENSE #