Provider Demographics
NPI:1518785526
Name:BRETTNER, BRUCE ALAN JR
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:BRETTNER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 LORRAINE ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-6036
Mailing Address - Country:US
Mailing Address - Phone:224-645-9565
Mailing Address - Fax:
Practice Address - Street 1:2714 LORRAINE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-6036
Practice Address - Country:US
Practice Address - Phone:246-459-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker