Healthcare Provider Details

I. General information

NPI: 1265769319
Provider Name (Legal Business Name): MELISSA L REINTJES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N WEST ST
ODON IN
47562-1032
US

IV. Provider business mailing address

PO BOX 760
WASHINGTON IN
47501-0760
US

V. Phone/Fax

Practice location:
  • Phone: 812-636-7300
  • Fax: 812-636-8204
Mailing address:
  • Phone: 812-254-2760
  • Fax: 812-254-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28105336A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003100A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: