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NPI Code Detail

MEDICARE: GRETCHEN M RIERSON MD

MEDICARE: GRETCHEN M RIERSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician45102MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306847314
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRETCHEN M RIERSON MD
Provider Business Mailing Address
First Line : 3955 PARKLAWN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55435-5655
Country : US
Telephone Number : 952-831-4454
Fax Number :
Provider Business Practice Location Address
First Line : 3955 PARKLAWN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55435-5655
Country : US
Telephone Number : 952-831-4454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 07/21/2022

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Directions to “ GRETCHEN M RIERSON MD” Practice Location

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