Healthcare Provider Details

I. General information

NPI: 1710153523
Provider Name (Legal Business Name): MONICA REINAGEL LD/N CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6024 PINEHURST RD
BALTIMORE MD
21212-2921
US

IV. Provider business mailing address

732 DEEPDENE RD #16206
BALTIMORE MD
21210-2147
US

V. Phone/Fax

Practice location:
  • Phone: 410-756-0596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDX2808
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: