Provider Demographics
NPI:1114644085
Name:REICHOW, LISA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:REICHOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 S. ELIOT AVE. PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069
Mailing Address - Country:US
Mailing Address - Phone:320-358-0987
Mailing Address - Fax:320-358-3422
Practice Address - Street 1:460 S. ELIOT AVE.
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069
Practice Address - Country:US
Practice Address - Phone:320-358-0987
Practice Address - Fax:320-358-3422
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2467290163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse