Provider Demographics
NPI:1265769319
Name:REINTJES, MELISSA L (NP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:REINTJES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0760
Mailing Address - Country:US
Mailing Address - Phone:812-254-2760
Mailing Address - Fax:812-254-8636
Practice Address - Street 1:202 N WEST ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1032
Practice Address - Country:US
Practice Address - Phone:812-636-7300
Practice Address - Fax:812-636-8204
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28105336A363L00000X
IN71003100A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00834945OtherRAILROAD MEDICARE
INP00834945OtherRAILROAD MEDICARE
IN265130PPPMedicare PIN
IN859910F7Medicare PIN