Provider Demographics
NPI:1699498535
Name:RETTLER, REBECCA MAE (APNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAE
Last Name:RETTLER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W384N8280 HIGHLANDER DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-9654
Mailing Address - Country:US
Mailing Address - Phone:262-719-0292
Mailing Address - Fax:
Practice Address - Street 1:N57W24950 N CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-4383
Practice Address - Country:US
Practice Address - Phone:262-820-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13170-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily