Individual
CHRISTIN S REISENAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
405 STYNER AVE, MOSCOW, ID 83843-9394
(208) 882-8369
(208) 882-1887
Mailing address
PO BOX 9583, MOSCOW, ID 83843-0177
(208) 882-8369
(208) 882-1887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
M6554
ID
2085R0202X
Diagnostic Radiology Physician
Primary
M6554
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003901200
—
ID
05
—
8235863
—
WA
Enumeration date
02/23/2006
Last updated
05/16/2014
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