Provider Demographics
NPI:1356355994
Name:SMELCER, GRETCHEN JEANETTE (CRNA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:JEANETTE
Last Name:SMELCER
Suffix:
Gender:F
Credentials:CRNA
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 807
Mailing Address - Street 2:HWY 18 15555
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154
Mailing Address - Country:US
Mailing Address - Phone:601-857-5633
Mailing Address - Fax:601-857-0308
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-841-1234
Practice Address - Fax:505-841-1956
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR56029367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered