Provider Demographics
NPI:1831400605
Name:RETTELL-ISLA, LEANN MICHELLE (DO)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:MICHELLE
Last Name:RETTELL-ISLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S HERLONG AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3399
Mailing Address - Country:US
Mailing Address - Phone:803-325-1770
Mailing Address - Fax:803-325-1790
Practice Address - Street 1:200 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3399
Practice Address - Country:US
Practice Address - Phone:803-325-1770
Practice Address - Fax:803-325-1790
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-02177207Q00000X
SCDO1640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine