Provider Demographics
NPI:1043006745
Name:RETZLAFF, EMILY (LM, CPM)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:RETZLAFF
Suffix:
Gender:
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 MCKEE AVE SW APT 2
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-1986
Mailing Address - Country:US
Mailing Address - Phone:616-560-0774
Mailing Address - Fax:
Practice Address - Street 1:453 W NORTON AVE
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3703
Practice Address - Country:US
Practice Address - Phone:616-263-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000147176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife