Healthcare Provider Details

I. General information

NPI: 1992008742
Provider Name (Legal Business Name): ROBERTA VERNICE REICHENBACH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 W SMITH ST
YORKTOWN IN
47396-1199
US

IV. Provider business mailing address

10330 N MERIDIAN ST # 300
INDIANAPOLIS IN
46290-1024
US

V. Phone/Fax

Practice location:
  • Phone: 765-722-6130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003477A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003477A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: