Provider Demographics
NPI:1972671394
Name:NETHERTON, GRETCHEN (PNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:NETHERTON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5221
Mailing Address - Country:US
Mailing Address - Phone:336-884-0224
Mailing Address - Fax:336-884-5439
Practice Address - Street 1:400 E COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27260-5221
Practice Address - Country:US
Practice Address - Phone:336-884-0224
Practice Address - Fax:336-884-3471
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC212651363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0245JOtherNC HEALTH CHOICE
NC890245JMedicaid