Provider Demographics
NPI:1548560840
Name:RETZEL, GERALYN C (LMP,)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:C
Last Name:RETZEL
Suffix:
Gender:F
Credentials:LMP,
Other - Prefix:
Other - First Name:GERALYN
Other - Middle Name:C
Other - Last Name:RETZEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4107 W 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-7302
Mailing Address - Country:US
Mailing Address - Phone:509-628-7321
Mailing Address - Fax:
Practice Address - Street 1:720 W COURT ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4178
Practice Address - Country:US
Practice Address - Phone:509-545-6506
Practice Address - Fax:509-783-4455
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00084823163WP0808X
WAMA00015313225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist