Individual
ANN M REITAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2041 NE WILLIAMSON CT, STE B, BEND, OR 97701-3925
(541) 323-7456
(541) 323-4997
Mailing address
2041 NE WILLIAMSON CT, STE B, BEND, OR 97701-3925
(541) 323-7456
(541) 323-4997
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00487
OR
363A00000X
Physician Assistant
PA741
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00834452
MEDICARE RAILROAD
OR
05
—
500605525
—
OR
Enumeration date
08/31/2006
Last updated
04/11/2016
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