Healthcare Provider Details

I. General information

NPI: 1548560840
Provider Name (Legal Business Name): GERALYN C RETZEL LMP,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GERALYN C RETZEL RN

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W COURT ST SUITE 8
PASCO WA
99301-4178
US

IV. Provider business mailing address

4107 W 17TH AVE
KENNEWICK WA
99338-7302
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-6506
  • Fax: 509-783-4455
Mailing address:
  • Phone: 509-628-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00084823
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00015313
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: