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General NPI Number Information
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NPI Number | 1497067888
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Entity Type | Individual
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Provider Name | LUCAS C REICHERT CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1126 W GRAYHAWK LOOP
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City | ROOSEVELT
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State | UT
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Zip | 84066-1209
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Country | US
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Telephone | 207-659-8756
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Fax |
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Provider Business Mailing Address
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Address Line | 1126 W GRAYHAWK LOOP
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City | ROOSEVELT
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State | UT
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Zip | 84066-1209
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Country | US
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Telephone | 207-659-8756
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AA103014
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4967790-4406
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License Number State | UT
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