Healthcare Provider Details

I. General information

NPI: 1265697908
Provider Name (Legal Business Name): ALEKSANDRA NERETLJAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3034 E KERRY LN
PHOENIX AZ
85050-2525
US

IV. Provider business mailing address

3034 E. KERRY LN
PHX AZ
85050
UM

V. Phone/Fax

Practice location:
  • Phone: 602-373-4208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberD02537728
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: