Provider Demographics
NPI:1306608427
Name:HOLDEN, GRETCHEN (CNA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 43 1/2 ST S APT 201
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7327
Mailing Address - Country:US
Mailing Address - Phone:701-729-0068
Mailing Address - Fax:
Practice Address - Street 1:1033 43 1/2 ST S APT 201
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7327
Practice Address - Country:US
Practice Address - Phone:701-729-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND102963376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide