Provider Demographics
NPI:1316609241
Name:REIGLE, ERICA J (APNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:REIGLE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 N PORT WASHINGTON RD STE G-30
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3483
Mailing Address - Country:US
Mailing Address - Phone:262-643-4900
Mailing Address - Fax:
Practice Address - Street 1:11501 N PORT WASHINGTON RD STE G-30
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3483
Practice Address - Country:US
Practice Address - Phone:262-643-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10583-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily