Individual
SUSAN K RETZLAFF DEITRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
418 N WEBB RD, GRAND ISLAND, NE 68803-4045
(308) 382-1100
(308) 385-0796
Mailing address
PO BOX 5436, GRAND ISLAND, NE 68802-5436
(308) 384-9300
(484) 359-8909
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
829
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100250168
—
NE
01
—
37315
BCBS OF NE
NE
Enumeration date
07/29/2005
Last updated
02/14/2020
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