Individual
SUSAN L RETTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
8170 33RD AVE S, MC21110Q, BLOOMINGTON, MN 55425-4516
(952) 883-6805
(952) 883-6117
Mailing address
8170 33RD AVE S, MC21110Q, BLOOMINGTON, MN 55425-4516
(952) 883-6805
(952) 883-6117
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0612045
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179324100
—
MN
Enumeration date
04/05/2006
Last updated
11/17/2008
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