Provider Demographics
NPI:1659635738
Name:REITER, HEIDI SHANNON (NP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:SHANNON
Last Name:REITER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0160
Mailing Address - Country:US
Mailing Address - Phone:701-587-6000
Mailing Address - Fax:701-587-6009
Practice Address - Street 1:900 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4520
Practice Address - Country:US
Practice Address - Phone:701-530-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26834363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner