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NPI Code Detail

MEDICARE: KIMBERLY V REISENWITZ CRNP

MEDICARE: KIMBERLY V REISENWITZ CRNP
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
1363L00000XNurse Practitioner1055707AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151536198OTHERALBCBS OF ALABAMA

General Provider Information

NPI Number : 1548365430
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY V REISENWITZ CRNP
Provider Business Mailing Address
First Line : 1958 CARTER GROVE RD
Second Line :
City : HAZEL GREEN
State : AL
Zip : 35750-8327
Country : US
Telephone Number : 256-828-1695
Fax Number :
Provider Business Practice Location Address
First Line : 4030 PEPPERWOOD CIR SW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35801-6499
Country : US
Telephone Number : 256-539-6536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 07/08/2007

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