MEDICARE: MRS. SANDRA M. RIETH MSN ANP-BC CNRN CCRN

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	209007269	IL
2	363LA2200X	Adult Health Nurse Practitioner	137630	MO
3	363LA2200X	Adult Health Nurse Practitioner	ARNP9432148	FL

General Provider Information

NPI Number	:	1942392816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA M. RIETH MSN ANP-BC CNRN CCRN

Provider Business Mailing Address
First Line	:	2564 COMMERCE PKWY
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9337
Country	:	US
Telephone Number	:	941-893-2733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2564 COMMERCE PKWY
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9337
Country	:	US
Telephone Number	:	941-893-2733
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	05/11/2018

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