Provider Demographics
NPI:1730219908
Name:NYLANDER, GRETCHEN MARIE (ATC)
Entity type:Individual
Prefix:MISS
First Name:GRETCHEN
Middle Name:MARIE
Last Name:NYLANDER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 SW PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9798
Mailing Address - Country:US
Mailing Address - Phone:503-628-6889
Mailing Address - Fax:
Practice Address - Street 1:2400 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1461
Practice Address - Country:US
Practice Address - Phone:503-554-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT- AT 4086672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer