Provider Demographics
NPI:1003444548
Name:BRIETZKE, EVAN (MSN, APRN, ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:BRIETZKE
Suffix:
Gender:M
Credentials:MSN, APRN, ACNPC-AG
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:
Other - Last Name:BRIETZKE-GUPTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, APRN, ACNPC-AG
Mailing Address - Street 1:5325 NINA LEE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-5211
Mailing Address - Country:US
Mailing Address - Phone:713-385-9110
Mailing Address - Fax:
Practice Address - Street 1:5325 NINA LEE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-5211
Practice Address - Country:US
Practice Address - Phone:713-385-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145219363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care