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General NPI Number Information
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NPI Number | 1720378128
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Entity Type | Organization
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Legal Business Name | GALAHADD'S QUEST LLC
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 2440 BATON ROUGE
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City | LIMA
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State | OH
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Zip | 45805-5104
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Country | US
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Telephone | 419-331-2273
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Fax | 419-331-4274
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Provider Business Mailing Address
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Address Line | 2440 BATON ROUGE SUITE 306
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City | LIMA
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State | OH
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Zip | 45805-5104
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Country | US
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Telephone | 419-331-2273
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Fax | 419-331-4274
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFREY ALAN REICHARDT
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Credential | CNP
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Telephone | 419-331-2273
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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 | COA10079-NP
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License Number State | OH
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