Provider Demographics
NPI:1285062638
Name:UTTERBACK, GRETCHANN ELIZABETH (PCPNP)
Entity type:Individual
Prefix:
First Name:GRETCHANN
Middle Name:ELIZABETH
Last Name:UTTERBACK
Suffix:
Gender:
Credentials:PCPNP
Other - Prefix:
Other - First Name:GRETCHANN
Other - Middle Name:ELIZABETH
Other - Last Name:FONDREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 CHERRY ST STE 1900
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2673
Mailing Address - Country:US
Mailing Address - Phone:419-251-3878
Mailing Address - Fax:
Practice Address - Street 1:2213 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1402
Practice Address - Country:US
Practice Address - Phone:419-251-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15291363LP0200X
OH15291363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096014Medicaid