Provider Demographics
NPI:1255603031
Name:DELOACH, GRETCHEN ANGELA (RN)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANGELA
Last Name:DELOACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 CAMDEN LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1392
Mailing Address - Country:US
Mailing Address - Phone:330-998-6063
Mailing Address - Fax:330-998-6063
Practice Address - Street 1:2147 CAMDEN LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1392
Practice Address - Country:US
Practice Address - Phone:330-998-6063
Practice Address - Fax:330-998-6063
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN257901163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health