Healthcare Provider Details

I. General information

NPI: 1013220961
Provider Name (Legal Business Name): GRETCHEN O'BRIEN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN EHRENZELLER GRETCHEN BOUCHER, NP

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 CHESTNUT ST
NEEDHAM MA
02492-2505
US

IV. Provider business mailing address

185 PILGRIM RD BAKER 4
BOSTON MA
02215-5324
US

V. Phone/Fax

Practice location:
  • Phone: 781-453-7750
  • Fax: 781-453-7770
Mailing address:
  • Phone: 617-667-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN232134
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: