Individual
GRETCHEN MARIE POTSCHKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2385
(360) 414-2386
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00042178
WA
208000000X
Pediatrics Physician
MD00042178
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171088
LABOR & IND.
WA
05
—
226976
—
OR
05
—
8359192
—
WA
01
—
8932202
CRIME VICTIMS
WA
01
—
P00019811
RR MEDICARE
—
Enumeration date
07/07/2005
Last updated
01/10/2013
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