Individual
MRS. LOGAN M RETTEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 HEIDI LN S, LAKELAND, FL 33813-2321
(727) 251-2044
Mailing address
1211 HEIDI LN S, LAKELAND, FL 33813-2321
(727) 251-2044
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA320
LICENSE
FL
Enumeration date
11/13/2015
Last updated
02/01/2016
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