Provider Demographics
NPI:1871549162
Name:FITZGERALD, GRETCHEN PARKER (CRNP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:PARKER
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2166 S 12TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-8701
Practice Address - Country:US
Practice Address - Phone:610-969-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006328C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1420024OtherKEYSTONE CENTRAL
PAP00235279OtherRAILROAD MEDICARE
PA50045336OtherCAPITAL BLUE CROSS
PA060659Medicare ID - Type Unspecified
PA060659KZNMedicare PIN