Healthcare Provider Details

I. General information

NPI: 1962160036
Provider Name (Legal Business Name): CHRISTINA ROSE TRETBAR RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA ROSE MACKLEY

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 56TH ST S STE D
FARGO ND
58104-4845
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3725
  • Fax:
Mailing address:
  • Phone: 605-328-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number2494750
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR46238
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: