Provider Demographics
NPI:1639112253
Name:TRETTER, ELAINE CARMELLA (LIC AC, RN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:CARMELLA
Last Name:TRETTER
Suffix:
Gender:F
Credentials:LIC AC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 COPPER RIDGE DR.
Mailing Address - Street 2:APT T1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2348
Mailing Address - Country:US
Mailing Address - Phone:410-486-6598
Mailing Address - Fax:
Practice Address - Street 1:1134 YORK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6215
Practice Address - Country:US
Practice Address - Phone:410-486-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01370171100000X
PAKO000539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist