Healthcare Provider Details

I. General information

NPI: 1861700825
Provider Name (Legal Business Name): ROBERT LAWRENCE REINHARDT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 LAPORTE AVE
VALPARAISO IN
46383-6996
US

IV. Provider business mailing address

PO BOX 2402
VALPARAISO IN
46384-2402
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-9389
  • Fax: 219-476-9432
Mailing address:
  • Phone: 219-477-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28150110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: