Provider Demographics
NPI:1174831119
Name:JOSEPH, RENATA REICHELT
Entity Type:Individual
Prefix:MRS
First Name:RENATA
Middle Name:REICHELT
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 COUNTY HIGHWAY 36 A
Mailing Address - Street 2:
Mailing Address - City:SCHENEVUS
Mailing Address - State:NY
Mailing Address - Zip Code:12155
Mailing Address - Country:US
Mailing Address - Phone:607-638-8090
Mailing Address - Fax:
Practice Address - Street 1:545 COUNTY HIGHWAY 36A
Practice Address - Street 2:
Practice Address - City:SCHENEVUS
Practice Address - State:NY
Practice Address - Zip Code:12155-3115
Practice Address - Country:US
Practice Address - Phone:607-638-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY549809163W00000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics