Provider Demographics
NPI:1851843130
Name:FLANAGAN, GRETCHEN (RD)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PALO ALTO WAY
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6139
Mailing Address - Country:US
Mailing Address - Phone:650-380-4809
Mailing Address - Fax:650-854-4475
Practice Address - Street 1:1901 PALO ALTO WAY
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6139
Practice Address - Country:US
Practice Address - Phone:650-380-4809
Practice Address - Fax:650-854-4475
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered