Basic Information
| Provider Information | |||||||||
| NPI: | 1134545411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STROBERG | ||||||||
| FirstName: | GRETCHEN | ||||||||
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| OtherLastName: | STRATHE | ||||||||
| OtherFirstName: | GRETCHEN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8200 W CENTRAL AVE | ||||||||
| Address2: | SUITE ONE | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672129503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167214544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8200 W CENTRAL AVE | ||||||||
| Address2: | SUITE ONE | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672129503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167214544 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2014 | ||||||||
| LastUpdateDate: | 10/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1902 | KS | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.