Healthcare Provider Details

I. General information

NPI: 1659975092
Provider Name (Legal Business Name): GRETCHEN C BURCHELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 SE STARK ST STE 265
GRESHAM OR
97030-3388
US

IV. Provider business mailing address

25050 SE STARK ST STE 265
GRESHAM OR
97030-3388
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-1520
  • Fax:
Mailing address:
  • Phone: 503-674-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number201902359RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202211966NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number61344536
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202211966NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: