Provider Demographics
NPI:1538982301
Name:MICCA R. RIEDEL NP PLLC
Entity type:Organization
Organization Name:MICCA R. RIEDEL NP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:409-291-8710
Mailing Address - Street 1:610 STRICKLAND DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4788
Mailing Address - Country:US
Mailing Address - Phone:409-291-8710
Mailing Address - Fax:409-247-2105
Practice Address - Street 1:610 STRICKLAND DR STE 130
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4788
Practice Address - Country:US
Practice Address - Phone:409-291-8710
Practice Address - Fax:409-247-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty