Provider Demographics
NPI:1073502357
Name:REICH, BRENDA (PAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-0050
Mailing Address - Country:US
Mailing Address - Phone:701-742-3267
Mailing Address - Fax:701-742-3201
Practice Address - Street 1:420 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-2024
Practice Address - Country:US
Practice Address - Phone:701-742-3267
Practice Address - Fax:701-742-3201
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0068363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18199OtherBLUE SHIELD
ND28584OtherBLUE SHIELD
ND71048Medicaid
ND18197OtherBLUE SHIELD
ND18198OtherBLUE SHIELD
ND18201OtherBLUE SHIELD
ND18202OtherBLUE SHIELD
ND970009838OtherRAILROAD MEDICARE
NDCF8850OtherRAILROAD MEDICARE
ND71058Medicaid
ND25960OtherBLUE SHIELD
ND28584OtherBLUE SHIELD
ND18198OtherBLUE SHIELD
NDN715792Medicare PIN
ND18197OtherBLUE SHIELD
ND18199OtherBLUE SHIELD
NDCF8850Medicare PIN