Provider Demographics
NPI:1659883072
Name:RETZLAFF, ERIKA JO
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:JO
Last Name:RETZLAFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 S KNOX DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2606
Mailing Address - Country:US
Mailing Address - Phone:719-568-4650
Mailing Address - Fax:
Practice Address - Street 1:917 S KNOX DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2606
Practice Address - Country:US
Practice Address - Phone:719-568-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program