Provider Demographics
NPI:1063418317
Name:RETZER, DEBRA ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:RETZER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9654
Mailing Address - Country:US
Mailing Address - Phone:262-993-1407
Mailing Address - Fax:262-376-0730
Practice Address - Street 1:10701 W RESEARCH DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3452
Practice Address - Country:US
Practice Address - Phone:262-993-1407
Practice Address - Fax:262-376-0730
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2104-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43991700Medicaid