Healthcare Provider Details

I. General information

NPI: 1487606653
Provider Name (Legal Business Name): REYNE A VIERGUTZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W NORFOLK AVE
NORFOLK NE
68701-4438
US

IV. Provider business mailing address

PO BOX 5126
SIOUX FALLS SD
57117-5126
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-4880
  • Fax: 402-644-7647
Mailing address:
  • Phone: 605-335-1952
  • Fax: 605-373-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100380
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: