Provider Demographics
NPI:1538196654
Name:KAIZER, GRETCHEN A (PA, RN)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:A
Last Name:KAIZER
Suffix:
Gender:F
Credentials:PA, RN
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:406 S. 30TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902
Mailing Address - Country:US
Mailing Address - Phone:509-248-7715
Mailing Address - Fax:509-248-2890
Practice Address - Street 1:406 S. 30TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-248-7715
Practice Address - Fax:509-248-2890
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA1005039363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8454266Medicaid
WA8861314Medicare PIN
NDP53749Medicare UPIN