Provider Demographics
NPI:1780770495
Name:GRETZ, SELINDA SUE (RN-CFNP)
Entity type:Individual
Prefix:MS
First Name:SELINDA
Middle Name:SUE
Last Name:GRETZ
Suffix:
Gender:F
Credentials:RN-CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16455 HERBAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-832-2251
Mailing Address - Fax:
Practice Address - Street 1:VA GULF COAST VETERANS HEALTH CARE SYSTEM
Practice Address - Street 2:400 VETERANS BOULEVARD
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-523-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR552828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily