Provider Demographics
NPI:1013951490
Name:STUCIN, GRETCHEN RENEE
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:RENEE
Last Name:STUCIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 GATCHELL RD SE
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-2347
Mailing Address - Country:US
Mailing Address - Phone:740-922-0387
Mailing Address - Fax:
Practice Address - Street 1:4799 GATCHELL RD SE
Practice Address - Street 2:
Practice Address - City:UHRICHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44683-2347
Practice Address - Country:US
Practice Address - Phone:740-922-0387
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
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
OH2240015Medicaid