Provider Demographics
NPI:1659975092
Name:BURCHELL, GRETCHEN C (FNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:C
Last Name:BURCHELL
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 1:25050 SE STARK ST STE 265
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3388
Mailing Address - Country:US
Mailing Address - Phone:503-674-1520
Mailing Address - Fax:
Practice Address - Street 1:25050 SE STARK ST STE 265
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3388
Practice Address - Country:US
Practice Address - Phone:503-674-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201902359RN163WI0500X
OR202211966NP-PP363L00000X, 363LF0000X
WA61344536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner