Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99336 | TX |
NPI | 1174016869 |
---|---|
Provider Name | Gretchen Ann Ort |
First Address | Ennis, TX 75119-7501 |
Second Address | Ennis, TX 75119-7501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |