Provider Demographics
NPI:1841259223
Name:STUWE-KEOHANE, GRETCHEN (RN,CS)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:STUWE-KEOHANE
Suffix:
Gender:F
Credentials:RN,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1821
Mailing Address - Country:US
Mailing Address - Phone:978-524-8181
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 126Q
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-524-8181
Practice Address - Fax:978-524-9868
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148526363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP0114OtherBLUE CROSS BLUE SHIELD
MANP0114OtherBLUE CROSS BLUE SHIELD
MAKE NP0114Medicare ID - Type Unspecified