Healthcare Provider Details

I. General information

NPI: 1639112253
Provider Name (Legal Business Name): ELAINE CARMELLA TRETTER LIC. AC., RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 YORK RD SUITE 208
LUTHERVILLE TIMONIUM MD
21093-6215
US

IV. Provider business mailing address

6503 COPPER RIDGE DR. APT T1
BALTIMORE MD
21209-2348
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-8380
  • Fax:
Mailing address:
  • Phone: 410-486-6598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01370
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberKO000539
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: