Provider Demographics
NPI:1851723316
Name:ANDERSON, GRETCHEN JANE (RN,BSW)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:JANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN,BSW
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 7
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-0007
Mailing Address - Country:US
Mailing Address - Phone:360-446-0688
Mailing Address - Fax:
Practice Address - Street 1:405 KILLION CT NW
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9411
Practice Address - Country:US
Practice Address - Phone:360-446-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00045140163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse