Provider Demographics
NPI:1134400195
Name:HAMPSHIRE, GRETCHEN JOHANNA (RN)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:JOHANNA
Last Name:HAMPSHIRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:JOHANNA
Other - Last Name:VANDERMEULEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12360 SW HORIZON BLVD
Mailing Address - Street 2:#102
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9349
Mailing Address - Country:US
Mailing Address - Phone:323-620-1697
Mailing Address - Fax:
Practice Address - Street 1:1500 NE IRVING ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2243
Practice Address - Country:US
Practice Address - Phone:503-258-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200642204RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse