Basic Information
| Provider Information | |||||||||
| NPI: | 1689026692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREWS | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11027 BURBANK BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916012431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189858323 | ||||||||
| FaxNumber: | 8189858323 | ||||||||
| Practice Location | |||||||||
| Address1: | 11027 BURBANK BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916012431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189858323 | ||||||||
| FaxNumber: | 8185067066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2016 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA0400X | 95063337 | CA | N | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | 363LP0808X | 95015750 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.