Provider Demographics
NPI:1730312158
Name:NESS, GRETCHEN MARYANNE (LPN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MARYANNE
Last Name:NESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1512
Mailing Address - Country:US
Mailing Address - Phone:612-236-1700
Mailing Address - Fax:612-236-1701
Practice Address - Street 1:1132 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1512
Practice Address - Country:US
Practice Address - Phone:612-236-1700
Practice Address - Fax:612-236-1701
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 052305-3164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse