Provider Demographics
NPI:1376351403
Name:REICHENBERGER, RENEE COLEEN
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:COLEEN
Last Name:REICHENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 19TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4148
Mailing Address - Country:US
Mailing Address - Phone:701-500-0633
Mailing Address - Fax:
Practice Address - Street 1:107 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58704-1314
Practice Address - Country:US
Practice Address - Phone:701-626-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant