Provider Demographics
NPI:1346615739
Name:REINHARDT, RENEE JOYCE ECKLEY (CPNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:JOYCE ECKLEY
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:JOYCE
Other - Last Name:ECKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:4100 E COMMERCE WAY SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 E COMMERCE WAY SUITE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834
Practice Address - Country:US
Practice Address - Phone:915-575-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000253363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics