Healthcare Provider Details

I. General information

NPI: 1124673256
Provider Name (Legal Business Name): GRETCHEN GINDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 N WEST ST
OLNEY IL
62450-1160
US

IV. Provider business mailing address

800 E LOCUST ST
OLNEY IL
62450-2553
US

V. Phone/Fax

Practice location:
  • Phone: 618-392-9400
  • Fax:
Mailing address:
  • Phone: 618-395-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019732
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: