1538439385 NPI number — MRS. MICCA RACHEL RIEDEL ANP-C, GNP-BC

Table of content: MRS. MICCA RACHEL RIEDEL ANP-C, GNP-BC (NPI 1538439385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538439385 NPI number — MRS. MICCA RACHEL RIEDEL ANP-C, GNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIEDEL
Provider First Name:
MICCA
Provider Middle Name:
RACHEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-C, GNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERTS
Provider Other First Name:
MICCA
Provider Other Middle Name:
RACHEL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP-C. GNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538439385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 STRICKLAND DR
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77630-4786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-330-4885
Provider Business Mailing Address Fax Number:
409-330-4669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 STRICKLAND DR
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77630-4786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-330-4885
Provider Business Practice Location Address Fax Number:
409-330-4669
Provider Enumeration Date:
01/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  688868 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: AP121473 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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