Healthcare Provider Details

I. General information

NPI: 1639986946
Provider Name (Legal Business Name): MADELINE BRETZING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 S ROYLE RD STE 120
RIDGEFIELD WA
98642-7759
US

IV. Provider business mailing address

536 S ROYLE RD STE 120
RIDGEFIELD WA
98642-7759
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1086
  • Fax: 360-487-1088
Mailing address:
  • Phone: 360-487-1086
  • Fax: 360-487-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70048915
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP70048915
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: