Provider Demographics
NPI:1326412388
Name:CARRETTA, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:CARRETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 E REMBRANDT AVE
Mailing Address - Street 2:STE 117
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6859 E REMBRANDT AVE
Practice Address - Street 2:STE 117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3628
Practice Address - Country:US
Practice Address - Phone:480-632-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily