Provider Demographics
NPI:1265697908
Name:NERETLJAK, ALEKSANDRA
Entity type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:NERETLJAK
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 1:3034 E. KERRY LN
Mailing Address - Street 2:
Mailing Address - City:PHX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3034 E KERRY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-2525
Practice Address - Country:US
Practice Address - Phone:602-373-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD02537728173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist