Provider Demographics
NPI:1255374849
Name:ANDERSON-REITZ, LOWELL (NP)
Entity type:Individual
Prefix:
First Name:LOWELL
Middle Name:
Last Name:ANDERSON-REITZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:LOWELL
Other - Middle Name:
Other - Last Name:REITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-7610
Mailing Address - Fax:303-415-7618
Practice Address - Street 1:4747 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1131
Practice Address - Country:US
Practice Address - Phone:303-415-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001875207QH0002X, 363LA2200X
COAPN.0001875-NP363L00000X
COAPN-0001875-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163236602Medicaid
TX163236603Medicaid
CO9000151171Medicaid
TX163236602Medicaid
TX8D3323Medicare PIN
TX8L7186Medicare PIN
TXTXB129186Medicare PIN