MEDICARE: MRS. GRETCHEN ELENE OLDS RN, APRN, NP-C

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
1	363LF0000X	Family Nurse Practitioner	RN122840	GA
2	363LF0000X	Family Nurse Practitioner	122840	GA
3	363L00000X	Nurse Practitioner	67156	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1528006095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRETCHEN ELENE OLDS RN, APRN, NP-C

Provider Business Mailing Address
First Line	:	3821 MASTHEAD ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4679
Country	:	US
Telephone Number	:	505-998-7400
Fax Number	:	505-998-7740

Provider Business Practice Location Address
First Line	:	313 W COUNTRY CLUB RD STE 12
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-5804
Country	:	US
Telephone Number	:	575-627-5828
Fax Number	:	575-627-5835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	06/15/2023

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