Healthcare Provider Details

I. General information

NPI: 1588831663
Provider Name (Legal Business Name): CATHLEEN SUZANNE REITZ ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20805 W 151ST ST # 400
OLATHE KS
66061
US

IV. Provider business mailing address

20805 W 151ST ST # 400
OLATHE KS
66061-7249
US

V. Phone/Fax

Practice location:
  • Phone: 913-780-4900
  • Fax: 913-780-0949
Mailing address:
  • Phone: 913-780-4900
  • Fax: 913-780-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-76319
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: