Provider Demographics
NPI:1508692559
Name:BRETZ, HEATHER RAE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:BRETZ
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 1:121 W CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-3300
Mailing Address - Country:US
Mailing Address - Phone:501-556-7242
Mailing Address - Fax:
Practice Address - Street 1:1178 W CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-3406
Practice Address - Country:US
Practice Address - Phone:918-253-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist