Provider Demographics
NPI:1861700825
Name:REINHARDT, ROBERT LAWRENCE (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:REINHARDT
Suffix:
Gender:M
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:PO BOX 2402
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-2402
Mailing Address - Country:US
Mailing Address - Phone:219-477-9407
Mailing Address - Fax:
Practice Address - Street 1:2307 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6996
Practice Address - Country:US
Practice Address - Phone:219-476-9389
Practice Address - Fax:219-476-9432
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28150110A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse