Provider Demographics
NPI:1518568773
Name:REITENBAUGH, NORMA JEAN (QSP)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:JEAN
Last Name:REITENBAUGH
Suffix:
Gender:F
Credentials:QSP
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 1002
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-1002
Mailing Address - Country:US
Mailing Address - Phone:701-340-2090
Mailing Address - Fax:
Practice Address - Street 1:519 11TH ST NE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2745
Practice Address - Country:US
Practice Address - Phone:701-838-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND60926376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide