Healthcare Provider Details

I. General information

NPI: 1164746434
Provider Name (Legal Business Name): IDA R REIGHARD RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CLARK ST
BUTTE MT
59701-2328
US

IV. Provider business mailing address

400 S CLARK STREET
BUTTE MT
59701-1703
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-0461
  • Fax: 406-782-7435
Mailing address:
  • Phone: 406-723-2960
  • Fax: 406-723-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN23816
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: