Provider Demographics
NPI:1346620267
Name:REITER, CHANTELLE M (RN)
Entity Type:Individual
Prefix:MS
First Name:CHANTELLE
Middle Name:M
Last Name:REITER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CHANTELLE
Other - Middle Name:M
Other - Last Name:REITER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:15956 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6879
Mailing Address - Country:US
Mailing Address - Phone:623-760-2076
Mailing Address - Fax:
Practice Address - Street 1:10110 SOUTH 7650 EAST
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN157774146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT$$$$$$$$$Medicare PIN