Basic Information
| Provider Information | |||||||||
| NPI: | 1548560840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RETZEL | ||||||||
| FirstName: | GERALYN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LMP, | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RETZEL | ||||||||
| OtherFirstName: | GERALYN | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4107 W 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993387302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096287321 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 720 W COURT ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993014178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095456506 | ||||||||
| FaxNumber: | 5097834455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2010 | ||||||||
| LastUpdateDate: | 03/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN00084823 | WA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 225700000X | MA00015313 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.