Healthcare Provider Details

I. General information

NPI: 1366831471
Provider Name (Legal Business Name): REBECCA L REIGLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 MCKINLEY AVE NW
CANTON OH
44703
US

IV. Provider business mailing address

812 17TH ST NE
CANTON OH
44714-2316
US

V. Phone/Fax

Practice location:
  • Phone: 330-452-9812
  • Fax: 330-588-2216
Mailing address:
  • Phone: 330-471-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number12345
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: