Healthcare Provider Details

I. General information

NPI: 1104896406
Provider Name (Legal Business Name): JEFFREY L REICHEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 STAGELINE RD
HUDSON WI
54016-7848
US

IV. Provider business mailing address

8177 KIMBRO AVE N
STILLWATER MN
55082-8329
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6625
  • Fax: 651-275-1475
Mailing address:
  • Phone: 651-351-0517
  • Fax: 651-275-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0876111
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: