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NPI Code Detail

MEDICARE: CAROLYN MAE BREZLER LMP

MEDICARE: CAROLYN MAE BREZLER LMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMA60204666WA

General Provider Information

NPI Number : 1336437565
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN MAE BREZLER LMP
Provider Business Mailing Address
First Line : 1040 MEGAN CT E
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-8423
Country : US
Telephone Number : 360-434-3431
Fax Number :
Provider Business Practice Location Address
First Line : 200 BETHEL AVE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-5216
Country : US
Telephone Number : 360-876-4171
Fax Number : 360-876-3495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2011
Last Update Date : 07/21/2011

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Directions to “ CAROLYN MAE BREZLER LMP” Practice Location

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