MEDICARE: VICKY REITH 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	163WC1600X	Continuing Education/Staff Development Registered Nurse	102655-30	WI
2	163WE0003X	Emergency Registered Nurse	102655-30	WI

General Provider Information

NPI Number	:	1689084980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKY REITH RN

Provider Business Mailing Address
First Line	:	W273N4182 HICKORY GROVE DR
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-2242
Country	:	US
Telephone Number	:	414-840-7305
Fax Number	:

Provider Business Practice Location Address
First Line	:	W273N4182 HICKORY GROVE DR
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-2242
Country	:	US
Telephone Number	:	414-840-7305
Fax Number	:

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

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	05/07/2014

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Directions to “ VICKY REITH RN” Practice Location

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