Provider Demographics
NPI:1134628324
Name:ROWE, GRETCHEN MARIE
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MARIE
Last Name:ROWE
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 1:1035 CLARK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5145
Mailing Address - Country:US
Mailing Address - Phone:707-326-9820
Mailing Address - Fax:
Practice Address - Street 1:3400 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5142
Practice Address - Country:US
Practice Address - Phone:707-526-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker