Provider Demographics
NPI:1649433434
Name:BRETZ, SHANNON RAE (ARNP)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RAE
Last Name:BRETZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:555 S FLOYD ST STE 3019
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3822
Mailing Address - Country:US
Mailing Address - Phone:502-891-8700
Mailing Address - Fax:502-852-5825
Practice Address - Street 1:400 E GRAY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1740
Practice Address - Country:US
Practice Address - Phone:502-574-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46208363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology