Provider Demographics
NPI:1821426453
Name:HENNEGAN, GRETCHEN (NP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:HENNEGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25000 COUNTRY CLUB BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5344
Mailing Address - Country:US
Mailing Address - Phone:440-793-2255
Mailing Address - Fax:440-793-7194
Practice Address - Street 1:25000 COUNTRY CLUB BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-5344
Practice Address - Country:US
Practice Address - Phone:440-793-2255
Practice Address - Fax:440-793-7194
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15113-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology