Healthcare Provider Details

I. General information

NPI: 1164874699
Provider Name (Legal Business Name): GRETCHEN GREENWELL KEHOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESSENTIA HEALTH DULUTH CLINIC 400 EAST THIRD STREET
DULUTH MN
55805-1951
US

IV. Provider business mailing address

800 E 28TH ST MR11112
MINNEAPOLIS MN
55407-3723
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 612-863-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: