Provider Demographics
NPI:1487769717
Name:REICHERT, SALLY (CRNA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:REICHERT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:REICHERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:202 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1943
Mailing Address - Country:US
Mailing Address - Phone:406-345-3306
Mailing Address - Fax:406-345-3358
Practice Address - Street 1:202 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1943
Practice Address - Country:US
Practice Address - Phone:406-345-3306
Practice Address - Fax:406-345-3358
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR17896367500000X
MT22142367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered