Provider Demographics
NPI:1801623202
Name:GRETCHEN VAN FOSSAN LLC
Entity type:Organization
Organization Name:GRETCHEN VAN FOSSAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN FOSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:202-413-3342
Mailing Address - Street 1:3316 19TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1007
Mailing Address - Country:US
Mailing Address - Phone:202-413-3342
Mailing Address - Fax:
Practice Address - Street 1:804 PERSHING DR STE 5
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4436
Practice Address - Country:US
Practice Address - Phone:202-413-3342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty