Healthcare Provider Details

I. General information

NPI: 1568159390
Provider Name (Legal Business Name): GRETCHEN M MITCHELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

1437 N ARTESIAN AVE APT 2
CHICAGO IL
60622-2642
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5904
  • Fax:
Mailing address:
  • Phone: 630-707-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209027266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: