Provider Demographics
NPI:1346592961
Name:BRETZKE, ELLEN LORRAINE (RN)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LORRAINE
Last Name:BRETZKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:LORRAINE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1925 E JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6885
Mailing Address - Country:US
Mailing Address - Phone:480-507-1481
Mailing Address - Fax:
Practice Address - Street 1:1925 E JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6885
Practice Address - Country:US
Practice Address - Phone:480-507-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN105770163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool