Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 03800NP | OH |
NPI | 1033167572 |
---|---|
Provider Name | Gretchen M Gallucci |
First Address | Dublin, OH 43016-4141 |
Second Address | Columbus, OH 43214-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2704774 | (05) | OH |
P00333851 | RR MEDICARE (01) | OH |