MEDICARE: GRETCHEN DOUGLAS

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	163WS0200X	School Registered Nurse	623381	NY

General Provider Information

NPI Number	:	1942686597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN DOUGLAS

Provider Business Mailing Address
First Line	:	2198 CRUGER AVE APT 3N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1642
Country	:	US
Telephone Number	:	832-449-2488
Fax Number	:

Provider Business Practice Location Address
First Line	:	2198 CRUGER AVE APT 3N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1642
Country	:	US
Telephone Number	:	832-449-2488
Fax Number	:

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

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	08/05/2015

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Directions to “ GRETCHEN DOUGLAS ” Practice Location

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