Provider Demographics
NPI:1942320205
Name:GRETCHEN, SCOTT G
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:G
Last Name:GRETCHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69111 WEST RUSTIC DR
Mailing Address - Street 2:APT 49
Mailing Address - City:ST CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950
Mailing Address - Country:US
Mailing Address - Phone:740-310-7267
Mailing Address - Fax:
Practice Address - Street 1:69111 WEST RUSTIC DR
Practice Address - Street 2:APT 49
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-310-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2454179OtherINDEPENDENT PROVIDER