Provider Demographics
NPI:1114029097
Name:REICHENBACH, LINDA R
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:REICHENBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N MARKET ST
Mailing Address - Street 2:BOX 28
Mailing Address - City:LIVERPOOL
Mailing Address - State:PA
Mailing Address - Zip Code:17045-9607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 N MARKET ST
Practice Address - Street 2:BOX 28
Practice Address - City:LIVERPOOL
Practice Address - State:PA
Practice Address - Zip Code:17045-9607
Practice Address - Country:US
Practice Address - Phone:717-444-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-187156-L367500000X
PARN187156L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001437136OtherHIGHMARK BS
PA50032070OtherCAIC/CBC
PARN-187156-LOtherLICENCE
PA023688Medicare PIN