Healthcare Provider Details

I. General information

NPI: 1326014655
Provider Name (Legal Business Name): AMY K REISING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY K REISING

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 PHYSICIANS CT SUITE 1
EVANSVILLE IN
47715-4031
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-3153
  • Fax: 812-473-8166
Mailing address:
  • Phone: 812-479-3153
  • Fax: 812-473-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001405A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: