Healthcare Provider Details

I. General information

NPI: 1912595851
Provider Name (Legal Business Name): ELIZABETH MAE RETTEW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19650 CLUB HOUSE RD # 101
MONTGOMERY VILLAGE MD
20886-3003
US

IV. Provider business mailing address

1225 4TH ST NE
WASHINGTON DC
20002-3431
US

V. Phone/Fax

Practice location:
  • Phone: 301-208-1300
  • Fax: 301-208-8699
Mailing address:
  • Phone: 202-347-8512
  • Fax: 202-506-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024185180
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAC008144
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: