MEDICARE: NATHAN L REIMNITZ PA-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	363A00000X	Physician Assistant	12098	MN
2	363A00000X	Physician Assistant	7307-23	WI

General Provider Information

NPI Number	:	1598125817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN L REIMNITZ PA-C

Provider Business Mailing Address
First Line	:	3555 WILLOW LAKE BLVD
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5131
Country	:	US
Telephone Number	:	652-431-5330
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 WILLOW LAKE BLVD
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5131
Country	:	US
Telephone Number	:	652-431-5330
Fax Number	:

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

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	12/16/2025

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