Provider Demographics
NPI:1205542750
Name:BROWN, GRETCHEN ELIZABETH
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:WA
Mailing Address - Zip Code:98601-0251
Mailing Address - Country:US
Mailing Address - Phone:360-921-0889
Mailing Address - Fax:
Practice Address - Street 1:19701 NE 399TH ST
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:WA
Practice Address - Zip Code:98601-3236
Practice Address - Country:US
Practice Address - Phone:360-247-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00143741251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health