Provider Demographics
NPI:1497004832
Name:REIFF, BEVERLY RENAE (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:RENAE
Last Name:REIFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BEV
Other - Middle Name:RENAE
Other - Last Name:BALLWEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1543 6TH AVE. NORTH
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075
Mailing Address - Country:US
Mailing Address - Phone:701-642-4303
Mailing Address - Fax:
Practice Address - Street 1:22279 RIVER OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537
Practice Address - Country:US
Practice Address - Phone:218-739-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR108228-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse