Provider Demographics
NPI:1982798955
Name:REINER, TIMOTHY WAYNE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:REINER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-8518
Mailing Address - Country:US
Mailing Address - Phone:701-662-4764
Mailing Address - Fax:
Practice Address - Street 1:1031 7TH ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2719
Practice Address - Country:US
Practice Address - Phone:701-662-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR16487367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30344Medicare ID - Type UnspecifiedCRNA