Individual
JACQLYNN S REITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
812 N 22ND ST, BLAIR, NE 68008-1128
(402) 426-4611
Mailing address
11813 MARY ST, OMAHA, NE 68164-6835
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2452
NE
363A00000X
Physician Assistant
Primary
2452
NE
Other
Enumeration date
03/03/2020
Last updated
04/27/2020
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