Tanya Rettig, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209017713 Issued in IL

Practice address

7804 Wooded Shore Dr
Wonder Lake, IL 60097-9312

Phone

(815) 388-2424

NPI assigned

Oct 30, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1871060731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 OKLAHOMA AVE",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600884214",
            "telephone_number": "815-388-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7804 WOODED SHORE DR",
            "city": "WONDER LAKE",
            "state": "IL",
            "postal_code": "600979312",
            "telephone_number": "815-388-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETTIG",
        "first_name": "TANYA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-30",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209017713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Wonder Lake, IL
• Providers in Wonder Lake, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.