Provider Demographics
NPI:1205587714
Name:REITZ, MICHELLE NICOLE (RN)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:REITZ
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 1:7450 HOLLY HILL DR APT 118
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5318
Mailing Address - Country:US
Mailing Address - Phone:817-454-5631
Mailing Address - Fax:
Practice Address - Street 1:2696 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6441
Practice Address - Country:US
Practice Address - Phone:972-370-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse