Provider Demographics
NPI:1114698263
Name:REYES, NESTORIO NEIL U
Entity Type:Individual
Prefix:
First Name:NESTORIO NEIL
Middle Name:U
Last Name:REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1141
Mailing Address - Country:US
Mailing Address - Phone:630-969-2900
Mailing Address - Fax:630-967-1964
Practice Address - Street 1:3450 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1141
Practice Address - Country:US
Practice Address - Phone:630-969-2900
Practice Address - Fax:630-967-1964
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.479966163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice