Individual
GRETCHEN VAN DER PERREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 HALL AVE STE B, MARINETTE, WI 54143-1604
(715) 732-7700
Mailing address
2543 TELLURIDE TRL APT C, GREEN BAY, WI 54313-3972
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9795-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511802080008
BLUE CROSS
WI
Enumeration date
08/31/2006
Last updated
07/08/2007
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