Basic Information
| Provider Information | |||||||||
| NPI: | 1982902557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REICH | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AARON | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | CHRISTINE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1949 GUNBARREL RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954349 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 GLENWOOD DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374041108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234957778 | ||||||||
| FaxNumber: | 4234957797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2011 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 21592 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LW0102X | 21592 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 000000705308 | 01 | KY | ANTHEM PIN | OTHER | 9343664 | 01 | KY | AETNA PIN | OTHER | 7100154580 | 05 | KY | MEDICAID |