Provider Demographics
NPI:1326003583
Name:O'REILLY, RITA K (CNM)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:K
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6005
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2203
Practice Address - Fax:612-904-4273
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN04348367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN478840100Medicaid
MN07-40050OtherMEDICA
MN46G42OROtherBLUE CROSS BLUE SHIELD
MN116093OtherUCARE
MN478840100Medicaid
MN420000040Medicare Oscar/Certification
MN07-40050OtherMEDICA