Provider Demographics
NPI:1346064763
Name:REIFSTECK, MEDELISE SUMMA (LIC AC)
Entity type:Individual
Prefix:
First Name:MEDELISE
Middle Name:SUMMA
Last Name:REIFSTECK
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD RD STE B204
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4165
Mailing Address - Country:US
Mailing Address - Phone:401-294-1644
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD RD STE B204
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4165
Practice Address - Country:US
Practice Address - Phone:401-294-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDACM00108171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist