Individual provider Active NPI

Gretchen Marie Clavey, RN

  • Registered Nurse
  • Champaign, IL
National Provider Identifier
1457959470
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
041.501601 Issued in IL
Practice address
1711 Mayfair Rd
Champaign, IL 61821-5522
Phone
(217) 480-7436
NPI assigned
Oct 12, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.501601 IL Primary

Addresses

Primary practice location

1711 Mayfair Rd
Champaign, IL 61821-5522

Mailing address

1711 Mayfair Rd
Champaign, IL 61821-5522
Phone (217) 480-7436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
041.501601ILMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1457959470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 MAYFAIR RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215522",
            "telephone_number": "217-480-7436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 MAYFAIR RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215522",
            "telephone_number": "217-480-7436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAVEY",
        "first_name": "GRETCHEN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-12",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.501601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.