MEDICARE: MRS. TAMARA REETER NP-C

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	163W00000X	Registered Nurse	840869	TX
2	363LA2200X	Adult Health Nurse Practitioner	840869	TX

General Provider Information

NPI Number	:	1437589017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA REETER NP-C

Provider Business Mailing Address
First Line	:	15108 LONE SPRING DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-3146
Country	:	US
Telephone Number	:	217-821-1072
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W WHITE OAKS DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6410
Country	:	US
Telephone Number	:	217-717-4404
Fax Number	:

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

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	11/11/2021

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