Provider Demographics
NPI:1780677369
Name:REITZ, STEVEN C (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:REITZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SADDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:ID
Mailing Address - Zip Code:83872-9772
Mailing Address - Country:US
Mailing Address - Phone:208-883-3406
Mailing Address - Fax:
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3056
Practice Address - Country:US
Practice Address - Phone:208-883-4511
Practice Address - Fax:208-883-6571
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006755367500000X
IDRNA-632367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA4381OtherBC ID
ID807070200Medicaid
WA9642851Medicaid
P00372632OtherRAILROAD MEDICARE
IDN434380OtherIDAHO LICENSE
ID807070200Medicaid