1790449569 NPI number — MISS GRETCHEN NICOLE WIESE MS, RD

Table of content: MISS GRETCHEN NICOLE WIESE MS, RD (NPI 1790449569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790449569 NPI number — MISS GRETCHEN NICOLE WIESE MS, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIESE
Provider First Name:
GRETCHEN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS, RD
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:
1790449569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 E MISSISSIPPI AVE APT 27-203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80224-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12100 E ILIFF AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-262-7281
Provider Business Practice Location Address Fax Number:
720-372-4504
Provider Enumeration Date:
10/27/2021

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:  86080414 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com