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General NPI Number Information
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NPI Number | 1205951266
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Entity Type | Individual
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Provider Name | GRETCHEN A CUNNINGHAM CNP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 17000 W NORTH AVE STE 200E
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City | BROOKFIELD
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State | WI
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Zip | 53005-4425
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Country | US
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Telephone | 262-782-4270
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Fax |
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Provider Business Mailing Address
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Address Line | 17000 W NORTH AVE STE 200E
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City | BROOKFIELD
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State | WI
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Zip | 53005-4425
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Country | US
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Telephone | 262-782-4270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704346345
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP09077
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 16212
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License Number State | WI
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