Individual
JESSICA RETTERATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, APRN
Contact information
Practice address
35 APPLE GLEN RD, LONG LAKE, MN 55356-9429
(320) 237-8616
Mailing address
35 APPLE GLEN RD, LONG LAKE, MN 55356-9429
(320) 237-8616
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1953033
MN
163WC0200X
Critical Care Medicine Registered Nurse
R195303-3
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA1958
MN
Other
Enumeration date
08/15/2016
Last updated
01/27/2023
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