Provider Demographics
NPI:1366831471
Name:REIGLE, REBECCA L (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:REIGLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 17TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2316
Mailing Address - Country:US
Mailing Address - Phone:330-471-9235
Mailing Address - Fax:
Practice Address - Street 1:832 MCKINLEY AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703
Practice Address - Country:US
Practice Address - Phone:330-452-9812
Practice Address - Fax:330-588-2216
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12345163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult