Provider Demographics
NPI:1629298245
Name:RETTA, CHRISTINE ELLEN (RNC, MSN, NNP, CNS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:RETTA
Suffix:
Gender:F
Credentials:RNC, MSN, NNP, CNS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELLEN
Other - Last Name:TERNULLO-RETTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNC, MSN, NNP, CNS
Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-6043
Mailing Address - Fax:
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328454363LN0000X, 364SN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Not Answered364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal