Provider Demographics
NPI:1164746434
Name:REIGHARD, IDA R (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:IDA
Middle Name:R
Last Name:REIGHARD
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S CLARK STREET
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1703
Mailing Address - Country:US
Mailing Address - Phone:406-723-2960
Mailing Address - Fax:406-723-2404
Practice Address - Street 1:400 S CLARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2328
Practice Address - Country:US
Practice Address - Phone:406-782-0461
Practice Address - Fax:406-782-7435
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN23816163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator