Healthcare Provider Details

I. General information

NPI: 1528519899
Provider Name (Legal Business Name): GRETCHEN HANCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3527
US

IV. Provider business mailing address

300 W DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3527
US

V. Phone/Fax

Practice location:
  • Phone: 614-450-6215
  • Fax: 614-450-6215
Mailing address:
  • Phone: 614-450-6215
  • Fax: 614-450-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number195596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: