Provider Demographics
NPI:1760148480
Name:REINECKE, CARL MATTHEW (NP)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:MATTHEW
Last Name:REINECKE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SW LANE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2550
Mailing Address - Country:US
Mailing Address - Phone:785-233-0500
Mailing Address - Fax:785-233-0660
Practice Address - Street 1:920 SW LANE ST STE 200
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2550
Practice Address - Country:US
Practice Address - Phone:785-233-0500
Practice Address - Fax:785-233-0660
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80379-052363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner