Healthcare Provider Details

I. General information

NPI: 1326307174
Provider Name (Legal Business Name): MIRANDA L REICHLING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY RD
OMAHA NE
68124-2319
US

IV. Provider business mailing address

7710 MERCY RD STE 424
OMAHA NE
68124-2346
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-6176
  • Fax: 402-343-8765
Mailing address:
  • Phone: 402-398-6176
  • Fax: 402-343-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101190
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: