MEDICARE: MADELINE REISTROFFER ANP

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	363LA2200X	Adult Health Nurse Practitioner	62680	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194721464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE REISTROFFER ANP

Provider Business Mailing Address
First Line	:	391 SERPENTINE DR
Second Line	:	STE 500
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-3096
Country	:	US
Telephone Number	:	864-585-8221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 BOILING SPRINGS RD STE 2100
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4210
Country	:	US
Telephone Number	:	864-591-1700
Fax Number	:	864-591-0007

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/05/2019

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Directions to “ MADELINE REISTROFFER ANP” Practice Location

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