Healthcare Provider Details

I. General information

NPI: 1952218463
Provider Name (Legal Business Name): HEIDI REITER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 29TH AVE NE
MINNEAPOLIS MN
55418-2207
US

IV. Provider business mailing address

1417 29TH AVE NE
MINNEAPOLIS MN
55418-2207
US

V. Phone/Fax

Practice location:
  • Phone: 612-986-9060
  • Fax:
Mailing address:
  • Phone: 612-986-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11051154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: