Provider Demographics
NPI:1104896406
Name:REICHEL, JEFFREY L (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:REICHEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8177 KIMBRO AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-8329
Mailing Address - Country:US
Mailing Address - Phone:651-351-0517
Mailing Address - Fax:651-275-1475
Practice Address - Street 1:405 STAGELINE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7848
Practice Address - Country:US
Practice Address - Phone:715-531-6625
Practice Address - Fax:651-275-1475
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0876111367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN482T0REOtherBLUE CROSS
965621017315OtherPREFERREDONE
MN845542200Medicaid
MN430004947Medicare ID - Type Unspecified
MN482T0REOtherBLUE CROSS