Provider Demographics
NPI:1043670102
Name:PUSHPANGADAN, REENA (RN, JD)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:PUSHPANGADAN
Suffix:
Gender:F
Credentials:RN, JD
Other - Prefix:MISS
Other - First Name:REENA
Other - Middle Name:
Other - Last Name:PUSHPANGADAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6509
Mailing Address - Country:US
Mailing Address - Phone:215-767-4188
Mailing Address - Fax:
Practice Address - Street 1:310 CROSS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-6509
Practice Address - Country:US
Practice Address - Phone:215-767-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-505559L163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine