Provider Demographics
NPI:1831645670
Name:BRETCHES, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BRETCHES
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 1:71 G STREET NORTH EAST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823
Mailing Address - Country:US
Mailing Address - Phone:509-899-8900
Mailing Address - Fax:
Practice Address - Street 1:7563 COX ST NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-9243
Practice Address - Country:US
Practice Address - Phone:509-899-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10077088376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide