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General NPI Number Information
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NPI Number | 1356956932
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Entity Type | Individual
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Provider Name | TIMOTHY J REICHERT RN, BSN, NREMT-P
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Gender | Male
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 227 KLEINE ST
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City | DEERFIELD
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State | WI
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Zip | 53531-9596
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Country | US
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Telephone | 608-977-1764
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Fax |
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Provider Business Mailing Address
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Address Line | 227 KLEINE ST
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City | DEERFIELD
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State | WI
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Zip | 53531-9596
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Country | US
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Telephone | 608-977-1764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 224169
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License Number State | WI
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