Healthcare Provider Details

I. General information

NPI: 1104970094
Provider Name (Legal Business Name): CAROL A REITZ CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10725 E OLD SPANISH TRL
TUCSON AZ
85748-8236
US

IV. Provider business mailing address

PO BOX 17067
TUCSON AZ
85731-7067
US

V. Phone/Fax

Practice location:
  • Phone: 520-404-6772
  • Fax:
Mailing address:
  • Phone: 520-404-6772
  • Fax: 520-733-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 016443
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: