Provider Demographics
NPI:1053360081
Name:THORSON, GRETCHEN (RD,LD,CDE)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:THORSON
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1850
Mailing Address - Country:US
Mailing Address - Phone:641-620-1706
Mailing Address - Fax:
Practice Address - Street 1:1515 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3354
Practice Address - Country:US
Practice Address - Phone:641-842-3101
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01317133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered