Provider Demographics
NPI:1588942775
Name:RIEMENSCHNEIDER, MAGDELINE S (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MAGDELINE
Middle Name:S
Last Name:RIEMENSCHNEIDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5082
Mailing Address - Country:US
Mailing Address - Phone:702-840-3722
Mailing Address - Fax:833-450-5718
Practice Address - Street 1:2360 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5082
Practice Address - Country:US
Practice Address - Phone:702-840-3722
Practice Address - Fax:833-450-5718
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2936363A00000X
IL085004074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540OtherMEDICARE PTAN GROUP
ILP01398541OtherMEDICARE RAILROAD
ILCA4748OtherMEDICARE RAILROAD GROUP PTAN
ILF400122051OtherMEDICARE PTAN (CADENCE)