Provider Demographics
NPI:1124716899
Name:REIFEL, CHANDA EASTRIDGE (RN)
Entity type:Individual
Prefix:
First Name:CHANDA
Middle Name:EASTRIDGE
Last Name:REIFEL
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S SAM RAYBURN FWY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-7261
Mailing Address - Country:US
Mailing Address - Phone:903-813-8681
Mailing Address - Fax:903-813-8702
Practice Address - Street 1:704 S SAM RAYBURN FWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-7261
Practice Address - Country:US
Practice Address - Phone:903-813-8681
Practice Address - Fax:903-813-8702
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652353163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024438601Medicaid