Provider Demographics
NPI:1508199324
Name:REITZ, JOEL E (ANP, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:REITZ
Suffix:
Gender:M
Credentials:ANP, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:920 COMPASSION CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1645
Practice Address - Country:US
Practice Address - Phone:907-212-9115
Practice Address - Fax:907-212-3426
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1108363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022339Medicaid
AK1022339Medicaid