Provider Demographics
NPI:1639494685
Name:MATHEWSON, GRETCHEN K (FNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:K
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:BOX 1138
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-6854
Mailing Address - Fax:
Practice Address - Street 1:5 EAST 98TH STREET
Practice Address - Street 2:BOX 1138
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-6854
Practice Address - Fax:212-241-5333
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily