Provider Demographics
NPI:1073344479
Name:STOLTE, GRETCHEN LEIGH
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LEIGH
Last Name:STOLTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 SE 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4143
Mailing Address - Country:US
Mailing Address - Phone:206-949-6634
Mailing Address - Fax:
Practice Address - Street 1:4521 SE 48TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-4143
Practice Address - Country:US
Practice Address - Phone:206-949-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program