Provider Demographics
NPI:1689791378
Name:JONES, GRETCHEN CHRISTINE (LM)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:CHRISTINE
Last Name:JONES
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0972
Mailing Address - Country:US
Mailing Address - Phone:360-496-0303
Mailing Address - Fax:360-496-0308
Practice Address - Street 1:207 CENTER STREET EAST
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:360-832-2167
Practice Address - Fax:360-496-0308
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000269176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5409JOOtherREGENCE BLUE SHIELD
WA7800JOOtherREGENCE BLUE SHIELD
WA7113392Medicaid