Healthcare Provider Details

I. General information

NPI: 1861594590
Provider Name (Legal Business Name): JUDY RAE REINKING DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 N MAIN ST
ALGONA IA
50511-1822
US

IV. Provider business mailing address

1318 N MAIN ST
ALGONA IA
50511-1822
US

V. Phone/Fax

Practice location:
  • Phone: 515-295-9644
  • Fax: 515-295-9644
Mailing address:
  • Phone: 515-295-9644
  • Fax: 515-295-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberIA509
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0018127
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: