Provider Demographics
NPI:1194721464
Name:REISTROFFER, MADELINE (ANP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:REISTROFFER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 SERPENTINE DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3096
Mailing Address - Country:US
Mailing Address - Phone:864-585-8221
Mailing Address - Fax:
Practice Address - Street 1:1330 BOILING SPRINGS RD STE 2100
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4210
Practice Address - Country:US
Practice Address - Phone:864-591-1700
Practice Address - Fax:864-591-0007
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62680363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0178Medicaid
SC6521Medicare PIN
SCQ31239Medicare PIN
SCNP0178Medicaid
SC7183Medicare PIN
SC5172Medicare PIN