1285927020 NPI number — GRETCHEN GRUENDER MS, RD, CSO

Table of content: GRETCHEN GRUENDER MS, RD, CSO (NPI 1285927020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285927020 NPI number — GRETCHEN GRUENDER MS, RD, CSO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUENDER
Provider First Name:
GRETCHEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CSO
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:
1285927020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10016 EDMONDS WAY, SUITE C-171
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMONDS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98020-5924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-670-0118
Provider Business Mailing Address Fax Number:
206-267-0073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6522 N FREMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-5924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-670-0118
Provider Business Practice Location Address Fax Number:
206-267-0073
Provider Enumeration Date:
05/26/2011

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: 133V00000X , with the licence number:  D100001650 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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