Provider Demographics
NPI:1689209900
Name:REECHER, SOPHIE SHARON (PA-C)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:SHARON
Last Name:REECHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WILLMAR AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3556
Mailing Address - Country:US
Mailing Address - Phone:320-231-5000
Mailing Address - Fax:
Practice Address - Street 1:283 SPRECKELS AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-6005
Practice Address - Country:US
Practice Address - Phone:209-953-3451
Practice Address - Fax:209-239-4246
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant