Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP145219 | TX |
NPI | 1003444548 |
---|---|
Provider Name | Evan Brietzke |
First Address | Houston, TX 77092-5211 |
Second Address | Houston, TX 77092-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2020 |
Last Update Date | 30/03/2020 |