MEDICARE: ELIZABETH MAE RETTEW APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	0024185180	VA
2	363LW0102X	Women's Health Nurse Practitioner	AC008144	MD

General Provider Information

NPI Number	:	1912595851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MAE RETTEW APRN

Provider Business Mailing Address
First Line	:	1225 4TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3431
Country	:	US
Telephone Number	:	202-347-8512
Fax Number	:	202-506-5372

Provider Business Practice Location Address
First Line	:	19650 CLUB HOUSE RD # 101
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-3003
Country	:	US
Telephone Number	:	301-208-1300
Fax Number	:	301-208-8699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	10/02/2025

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