Provider Demographics
NPI:1629793104
Name:HREZIK, ALICE JUTTA (RN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:JUTTA
Last Name:HREZIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRATENAHL
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1141
Mailing Address - Country:US
Mailing Address - Phone:216-323-9214
Mailing Address - Fax:
Practice Address - Street 1:3929 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4153
Practice Address - Country:US
Practice Address - Phone:216-252-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156369163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health