Provider Demographics
NPI:1710087093
Name:REINHARDT, LUCIA G (PA)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:G
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 480
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-5411
Mailing Address - Fax:612-625-6137
Practice Address - Street 1:424 HARVARD ST SE
Practice Address - Street 2:M-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0362
Practice Address - Country:US
Practice Address - Phone:612-625-5411
Practice Address - Fax:612-625-6137
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN918363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical