Provider Demographics
NPI:1093426892
Name:RIEKE, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:RIEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-2051
Mailing Address - Country:US
Mailing Address - Phone:612-208-5200
Mailing Address - Fax:
Practice Address - Street 1:1733 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-2051
Practice Address - Country:US
Practice Address - Phone:612-208-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9789363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health