Provider Demographics
NPI:1881903649
Name:SINCLAIR, GRETCHEN MARIA (FNP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MARIA
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:4800 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 127
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3628
Practice Address - Country:US
Practice Address - Phone:210-733-5072
Practice Address - Fax:210-733-8649
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX714323363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219545501Medicaid
TXTXB118832Medicare PIN
TXTXB156854Medicare PIN