Provider Demographics
NPI:1609352681
Name:RIETZ, GWENDI (LPN)
Entity Type:Individual
Prefix:
First Name:GWENDI
Middle Name:
Last Name:RIETZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2691
Mailing Address - Street 2:
Mailing Address - City:MILLS
Mailing Address - State:WY
Mailing Address - Zip Code:82644-2691
Mailing Address - Country:US
Mailing Address - Phone:307-277-1699
Mailing Address - Fax:
Practice Address - Street 1:3211 ENERGY LN STE 306
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2963
Practice Address - Country:US
Practice Address - Phone:307-277-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5840164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse