Provider Demographics
NPI:1982922449
Name:RETTMANN, GLENNA MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:GLENNA
Middle Name:MARIE
Last Name:RETTMANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 JACKSON ST
Mailing Address - Street 2:2302JACKSON
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-2424
Mailing Address - Country:US
Mailing Address - Phone:920-553-8623
Mailing Address - Fax:
Practice Address - Street 1:2302 JACKSON ST
Practice Address - Street 2:2302JACKSONSTREET
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-2424
Practice Address - Country:US
Practice Address - Phone:920-553-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20362-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse