Provider Demographics
NPI:1467870006
Name:REITANO, GENA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:REITANO
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E4506 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-8807
Mailing Address - Country:US
Mailing Address - Phone:608-209-5250
Mailing Address - Fax:
Practice Address - Street 1:E4506 MAPLE CT
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-8807
Practice Address - Country:US
Practice Address - Phone:608-209-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI136-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife