Healthcare Provider Details

I. General information

NPI: 1063620326
Provider Name (Legal Business Name): GRETCHEN ANNE ANDREWS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 BANYAN DR
REDLANDS CA
92373-6710
US

IV. Provider business mailing address

902 BANYAN DR
REDLANDS CA
92373-6710
US

V. Phone/Fax

Practice location:
  • Phone: 951-533-3606
  • Fax:
Mailing address:
  • Phone: 951-533-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: