Provider Demographics
NPI:1386451516
Name:REKLAITIS, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:REKLAITIS
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 1:415 IOWA ST.
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NE
Mailing Address - Zip Code:68728
Mailing Address - Country:US
Mailing Address - Phone:402-584-2040
Mailing Address - Fax:
Practice Address - Street 1:415 IOWA ST.
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NE
Practice Address - Zip Code:68728
Practice Address - Country:US
Practice Address - Phone:402-584-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion