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General NPI Number Information
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NPI Number | 1538982301
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Entity Type | Organization
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Legal Business Name | MICCA R. RIEDEL NP PLLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 610 STRICKLAND DR STE 130
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City | ORANGE
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State | TX
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Zip | 77630-4788
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Country | US
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Telephone | 409-291-8710
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Fax | 409-247-2105
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Provider Business Mailing Address
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Address Line | 610 STRICKLAND DR STE 130
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City | ORANGE
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State | TX
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Zip | 77630-4788
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Country | US
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Telephone | 409-291-8710
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Fax | 409-247-2105
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICCA R RIEDEL
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Credential | NP
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Telephone | 409-291-8710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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