Provider Demographics
NPI:1922421288
Name:BROMAN, GRETCHEN LORRAINE (APN, RN)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LORRAINE
Last Name:BROMAN
Suffix:
Gender:F
Credentials:APN, RN
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:LORRAINE
Other - Last Name:POEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, RN
Mailing Address - Street 1:16773 BERNARDO CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2525
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:21750 CENTER COURT DR. S SUITE 650
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:323-628-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010375363LF0000X
CA95007885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily