Provider Demographics
NPI:1295083038
Name:MANN, GRETCHEN (MD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 17TH ST., #479
Mailing Address - Street 2:DENVER MILITARY ENTRANCE AND PROCESSING STATION
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80293-0621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 17TH ST., #479
Practice Address - Street 2:DENVER MILITARY ENTRANCE AND PROCESSING STATION
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80293-0621
Practice Address - Country:US
Practice Address - Phone:303-623-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38205171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider