Individual
MISS BRANDI RAEANN RETASKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1414 W FAIR AVE, MARQUETTE, MI 49855-2675
(906) 226-4618
Mailing address
2083 HURON ST, MARQUETTE, MI 49855-1429
(906) 251-1667
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703096033
MI
Other
Enumeration date
10/19/2023
Last updated
10/19/2023
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