Provider Demographics
NPI:1548327760
Name:REICHE, DENNIS (FNP)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:REICHE
Suffix:
Gender:M
Credentials:FNP
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 601082
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1082
Mailing Address - Country:US
Mailing Address - Phone:864-885-7989
Mailing Address - Fax:864-885-7867
Practice Address - Street 1:867 WHITWORTH CIR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9435
Practice Address - Country:US
Practice Address - Phone:864-882-7400
Practice Address - Fax:864-882-7401
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1477207Q00000X
MI4704270788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1548327760Medicaid
SCP48193OtherMEDICARE PTAN
SCP48193OtherMEDICARE PTAN
MIMI1566004Medicare PIN