Provider Demographics
NPI:1083007124
Name:REISS, LAURA DANIELLE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DANIELLE
Last Name:REISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DANIELLE
Other - Last Name:BUCUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3151 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1263
Mailing Address - Country:US
Mailing Address - Phone:216-513-4020
Mailing Address - Fax:
Practice Address - Street 1:3151 CHARLES ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1263
Practice Address - Country:US
Practice Address - Phone:217-513-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.382514163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse