Healthcare Provider Details

I. General information

NPI: 1477510881
Provider Name (Legal Business Name): CHERYL LYNN REITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 W CEDAR VALLEY RD
DELAFIELD WI
53018-1756
US

IV. Provider business mailing address

66 W CEDAR VALLEY RD
DELAFIELD WI
53018-1756
US

V. Phone/Fax

Practice location:
  • Phone: 262-646-4969
  • Fax:
Mailing address:
  • Phone: 262-646-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95346-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: