Provider Demographics
NPI:1083211338
Name:REISCH, SUE ELLEN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:REISCH
Suffix:
Gender:F
Credentials:RN, BSN
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 715
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-0715
Mailing Address - Country:US
Mailing Address - Phone:507-283-5066
Mailing Address - Fax:507-283-5074
Practice Address - Street 1:2 ROUNDWIND RD
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1300
Practice Address - Country:US
Practice Address - Phone:507-283-5070
Practice Address - Fax:507-283-5074
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2484591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse