Provider Demographics
NPI:1356551162
Name:RETTBERG, THECLA ANN (RN,IBCLC,RLC,CIMI)
Entity type:Individual
Prefix:MRS
First Name:THECLA
Middle Name:ANN
Last Name:RETTBERG
Suffix:
Gender:F
Credentials:RN,IBCLC,RLC,CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 WINDING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4112
Mailing Address - Country:US
Mailing Address - Phone:630-675-4852
Mailing Address - Fax:
Practice Address - Street 1:247 WINDING CREEK DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-4112
Practice Address - Country:US
Practice Address - Phone:630-675-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse