Provider Demographics
NPI:1194842542
Name:REICHERT, ILSE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ILSE MARIE
Middle Name:
Last Name:REICHERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23819 NE SALAL PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-6276
Mailing Address - Country:US
Mailing Address - Phone:425-522-4826
Mailing Address - Fax:
Practice Address - Street 1:13033 BELLEVUE REDMOND RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2633
Practice Address - Country:US
Practice Address - Phone:425-454-1560
Practice Address - Fax:425-457-7107
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006743363LA2200X
IL209-003344363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL550350OtherPROVIDER NUMBER
ILS84986Medicare UPIN