Provider Demographics
NPI:1164119954
Name:REYES, JUDITH CUANAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:CUANAN
Last Name:REYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1636
Mailing Address - Country:US
Mailing Address - Phone:206-660-4419
Mailing Address - Fax:206-558-0543
Practice Address - Street 1:16748 CORLISS AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5554
Practice Address - Country:US
Practice Address - Phone:206-660-4419
Practice Address - Fax:206-558-0543
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00145579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse