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General NPI Number Information
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NPI Number | 1811709116
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Entity Type | Individual
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Provider Name | CAROL REICHENBEG
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 825 S 9TH AVE
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City | BROKEN BOW
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State | NE
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Zip | 68822-2475
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Country | US
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Telephone | 308-872-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 44104 DRIVE 803
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City | BROKEN BOW
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State | NE
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Zip | 68822-5560
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Country | US
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Telephone | 308-870-2269
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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 | 372500000X
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Taxonomy Name | Chore Provider
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License Number | G04005417
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License Number State | NE
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