Provider Demographics
NPI:1316042732
Name:REICHERT, PAUL B (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:REICHERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 W 1670 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9228
Mailing Address - Country:US
Mailing Address - Phone:801-796-5977
Mailing Address - Fax:
Practice Address - Street 1:750 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3660
Practice Address - Country:US
Practice Address - Phone:800-748-4868
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT198716-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7771OtherHEALTHY U
UTTPRA07641OtherMOLINA
UT47396OtherPEHP
UT870525882RE1OtherEDUCATORS MUTUAL
UT107008060102OtherIHC
UT343291OtherDESERET MUTUAL
UTQM0000076595OtherALTIUS