Healthcare Provider Details

I. General information

NPI: 1811543762
Provider Name (Legal Business Name): JENNA REITZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PTARMIGAN LN
HELENA MT
59602-0521
US

IV. Provider business mailing address

PO BOX 6369
HELENA MT
59604-6369
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-146340
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN73800
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: