Provider Demographics
NPI:1477327658
Name:RATZLAFF, BROCK NEWMAN (RN)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:NEWMAN
Last Name:RATZLAFF
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-952 MAKAKILO DR APT 72
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1368
Mailing Address - Country:US
Mailing Address - Phone:808-785-1688
Mailing Address - Fax:
Practice Address - Street 1:92-952 MAKAKILO DR APT 72
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1368
Practice Address - Country:US
Practice Address - Phone:808-785-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI107174163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse