Retzlaff Deitrick, Susan K

Retzlaff Deitrick, Susan K is an individual health care provider with primary practice located at 418 N Webb Rd , Grand Island NE 68803-4045. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Retzlaff Deitrick, Susan K can be contacted via phone (308) 382-1100.

Contact Information

Primary practice address
418 N Webb Rd Grand Island NE 68803-4045
Fax: (308) 385-0796
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 829 Nebraska

Profile Details

NPI number 1912907981
LBN Legal business name Retzlaff Deitrick, Susan K
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2005
Last updated Feb 14th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912907981 NPPES
Nebraska Other 37315 BCBS OF NE
Nebraska MEDICAID 100250168 BCBS OF NE

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