Provider Demographics
NPI:1780801654
Name:KIRKWOOD, GRETCHEN JOY (RN)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:JOY
Last Name:KIRKWOOD
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 1:722 SHADY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1282
Mailing Address - Country:US
Mailing Address - Phone:317-370-6546
Mailing Address - Fax:866-455-7198
Practice Address - Street 1:8060 KNUE RD
Practice Address - Street 2:STE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1976
Practice Address - Country:US
Practice Address - Phone:800-862-3310
Practice Address - Fax:314-842-7674
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28170318A163W00000X
FLRN 9235784163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse