Provider Demographics
NPI:1497745897
Name:REINECKE, KATHLEEN S (CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:REINECKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-6540
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:147 MILK ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4806
Practice Address - Country:US
Practice Address - Phone:617-654-7280
Practice Address - Fax:617-654-7363
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN2270438367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7794185Medicaid
VA7794185Medicaid