Provider Demographics
NPI:1811297831
Name:REINERS, ANGELA JAN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JAN
Last Name:REINERS
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 1:2456 475TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62635-6385
Mailing Address - Country:US
Mailing Address - Phone:217-376-3142
Mailing Address - Fax:
Practice Address - Street 1:2456 475TH AVE
Practice Address - Street 2:
Practice Address - City:EMDEN
Practice Address - State:IL
Practice Address - Zip Code:62635-6385
Practice Address - Country:US
Practice Address - Phone:217-376-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL158720813Medicaid