Individual
NATHANIEL JOSEPH RETRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
110 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-2351
Mailing address
110 EAST FIFTH AVENUE, ANTIGO, WI 54409
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3377-23
WI
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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