Provider Demographics
NPI:1689084980
Name:REITH, VICKY (RN)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:REITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W273N4182 HICKORY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2242
Mailing Address - Country:US
Mailing Address - Phone:414-840-7305
Mailing Address - Fax:
Practice Address - Street 1:W273N4182 HICKORY GROVE DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2242
Practice Address - Country:US
Practice Address - Phone:414-840-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI102655-30163WC1600X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development