Provider Demographics
NPI:1134445414
Name:PLETTNER, ELIZABETH ANNE
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:PLETTNER
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 1:1810 VIA PETIRROJO
Mailing Address - Street 2:B
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5951
Mailing Address - Country:US
Mailing Address - Phone:361-523-9609
Mailing Address - Fax:
Practice Address - Street 1:162 1ST ST
Practice Address - Street 2:
Practice Address - City:PORT HUENEME CBC BASE
Practice Address - State:CA
Practice Address - Zip Code:93043-4316
Practice Address - Country:US
Practice Address - Phone:805-989-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman