Provider Demographics
NPI:1790293223
Name:CALDWELL, GRETCHEN THERESA (FNP-C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:THERESA
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 SUMMIT CROSSING PL STE 306
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2183
Mailing Address - Country:US
Mailing Address - Phone:704-671-7930
Mailing Address - Fax:704-671-7835
Practice Address - Street 1:660 SUMMIT CROSSING PL STE 306
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2183
Practice Address - Country:US
Practice Address - Phone:704-671-7930
Practice Address - Fax:704-671-7835
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC198267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily