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General NPI Number Information
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NPI Number | 1568070209
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Entity Type | Individual
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Provider Name | ALICIA M REICHENBACH
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Gender | Female
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 3300 OAKDALE AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2926
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Country | US
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Telephone | 612-240-1949
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Fax |
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Provider Business Mailing Address
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Address Line | 3810 112TH CIR NE
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City | BLAINE
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State | MN
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Zip | 55449-6287
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7566
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License Number State | MN
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