Most Relevant Information
Provider Data
| NPI Number: | 1003434952 |
| Provider Name: | BRETZYL M LISCOE |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | APRN.CNP.0027013 |
Most Important Dates
| Enumeration Date: | 07/08/2020 |
| Last Updated: | 07/08/2020 |
Provider Practice Location
630 E RIVER ST
ELYRIA
OH
440355902
Practice Location Phone/Fax
| Phone: | 4403238515 |
| Fax: |
Provider Mailing Location
17703 HICKS RD
BEDFORD
OH
441464332
Provider Mailing Phone/Fax
| Phone: | 4405250811 |
| Fax: |