Healthcare Provider Details

I. General information

NPI: 1659635738
Provider Name (Legal Business Name): HEIDI SHANNON REITER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI JO SHANNON NP

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

PO BOX 160
NORTHWOOD ND
58267-0160
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-7000
  • Fax:
Mailing address:
  • Phone: 701-587-6000
  • Fax: 701-587-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR26834
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: