Provider Demographics
NPI:1255512331
Name:HUGHES, GRETTA JANE (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:GRETTA
Middle Name:JANE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1321
Mailing Address - Country:US
Mailing Address - Phone:612-673-5305
Mailing Address - Fax:612-673-3866
Practice Address - Street 1:250 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1321
Practice Address - Country:US
Practice Address - Phone:218-340-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030513363A00000X
VA0110002648363A00000X
MN11995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant