MEDICARE: MRS. BRENDA LEE GATCHEL CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	23799	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790720316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA LEE GATCHEL CRNP

Provider Business Mailing Address
First Line	:	960 S PROSPECT ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6225
Country	:	US
Telephone Number	:	740-383-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 S PROSPECT ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6225
Country	:	US
Telephone Number	:	740-383-2776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	01/16/2014

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