Provider Demographics
NPI:1528343266
Name:RETZKE, KARIN L (CNP)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:L
Last Name:RETZKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:L
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:MIDWEST BREAST & AESTHETIC SURGERY
Mailing Address - Street 2:1080 BEECHER CROSSING N, SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:855-687-6227
Mailing Address - Fax:881-681-9643
Practice Address - Street 1:MIDWEST BREAST & AESTHETIC SURGERY
Practice Address - Street 2:1080 BEECHER CROSSING N, SUITE A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:855-687-6227
Practice Address - Fax:881-681-9643
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12854363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059358Medicaid
OHH044410Medicare PIN