Provider Demographics
NPI:1164726188
Name:REIS, FAY P (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:FAY
Middle Name:P
Last Name:REIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LACASSE BLVD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N8N4P2
Mailing Address - Country:CA
Mailing Address - Phone:519-735-2010
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704157271367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered