MEDICARE: NICOLE LAURA REICHNER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP008072	PA
2	163WE0003X	Emergency Registered Nurse	SP008072	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00351745	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1667661	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1326034976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LAURA REICHNER CRNP

Provider Business Mailing Address
First Line	:	PO BOX 8500-6335
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0001
Country	:	US
Telephone Number	:	215-807-8000
Fax Number	:	215-807-8235

Provider Business Practice Location Address
First Line	:	3998 RED LION RD
Second Line	:	EMERGENCY MEDICINE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1436
Country	:	US
Telephone Number	:	215-612-4000
Fax Number	:	215-807-8235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/24/2007

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