Provider Demographics
NPI:1457959470
Name:CLAVEY, GRETCHEN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:MARIE
Last Name:CLAVEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5522
Mailing Address - Country:US
Mailing Address - Phone:217-480-7436
Mailing Address - Fax:
Practice Address - Street 1:1711 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5522
Practice Address - Country:US
Practice Address - Phone:217-480-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.501601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse