Healthcare Provider Details

I. General information

NPI: 1821709437
Provider Name (Legal Business Name): ISABEL CECEIL REUVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 250TH ST E
FARIBAULT MN
55021-8298
US

IV. Provider business mailing address

1135 250TH ST E
FARIBAULT MN
55021-8298
US

V. Phone/Fax

Practice location:
  • Phone: 507-384-2444
  • Fax:
Mailing address:
  • Phone: 507-384-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: