Provider Demographics
NPI:1447989751
Name:BRETZ, KAITLYN MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:BRETZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:EBERHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2 JENNIFER CT STE B
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7694
Mailing Address - Country:US
Mailing Address - Phone:717-960-3750
Mailing Address - Fax:717-960-3734
Practice Address - Street 1:2 JENNIFER CT STE B
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7694
Practice Address - Country:US
Practice Address - Phone:717-960-3750
Practice Address - Fax:717-960-3734
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF05220579363L00000X
PASP025802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner