Provider Demographics
NPI:1992022479
Name:ROSE, GRETCHEN ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:ROSE
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 1:107 N FARM RD APT 117
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1232
Mailing Address - Country:US
Mailing Address - Phone:715-305-6246
Mailing Address - Fax:
Practice Address - Street 1:107 N FARM RD APT 117
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1232
Practice Address - Country:US
Practice Address - Phone:715-305-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171585030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health