Provider Demographics
NPI:1104970094
Name:REITZ, CAROL A (CRNFA)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:REITZ
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17067
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-7067
Mailing Address - Country:US
Mailing Address - Phone:520-404-6772
Mailing Address - Fax:520-733-1398
Practice Address - Street 1:10725 E OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-8236
Practice Address - Country:US
Practice Address - Phone:520-404-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 016443163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant