1720336274 NPI number — GRETCHEN E MCCOOL CNM

Table of content: GRETCHEN E MCCOOL CNM (NPI 1720336274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720336274 NPI number — GRETCHEN E MCCOOL CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOOL
Provider First Name:
GRETCHEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720336274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 N JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53202-5917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-289-3796
Provider Business Mailing Address Fax Number:
414-431-0733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E CAPITOL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53212-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-493-1052
Provider Business Practice Location Address Fax Number:
414-291-5207
Provider Enumeration Date:
08/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  148890 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100037010 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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