Healthcare Provider Details

I. General information

NPI: 1780677369
Provider Name (Legal Business Name): STEVEN C REITZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S MAIN ST
MOSCOW ID
83843-3056
US

IV. Provider business mailing address

1233 SADDLE RIDGE RD
VIOLA ID
83872-9772
US

V. Phone/Fax

Practice location:
  • Phone: 208-883-4511
  • Fax: 208-883-6571
Mailing address:
  • Phone: 208-883-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-632
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30006755
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: