Healthcare Provider Details

I. General information

NPI: 1275450678
Provider Name (Legal Business Name): ADRIA ESTELLE BRIETZKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E H ST
IRON MOUNTAIN MI
49801-4760
US

IV. Provider business mailing address

N22740 TIMOTHY RD
NIAGARA WI
54151-9532
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4704361748
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number232631-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: