MEDICARE: CHANDA EASTRIDGE REIFEL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	652353	TX
2	163W00000X	Registered Nurse	652353	TX

General Provider Information

NPI Number	:	1124716899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDA EASTRIDGE REIFEL RN

Provider Business Mailing Address
First Line	:	704 S SAM RAYBURN FWY
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-7261
Country	:	US
Telephone Number	:	903-813-8681
Fax Number	:	903-813-8702

Provider Business Practice Location Address
First Line	:	704 S SAM RAYBURN FWY
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-7261
Country	:	US
Telephone Number	:	903-813-8681
Fax Number	:	903-813-8702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	01/21/2026

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