Provider Demographics
NPI:1215181391
Name:REEDY, RENA JO MIRANDA
Entity Type:Individual
Prefix:
First Name:RENA JO
Middle Name:MIRANDA
Last Name:REEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 ROSEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1717
Mailing Address - Country:US
Mailing Address - Phone:567-303-5676
Mailing Address - Fax:
Practice Address - Street 1:458 ROSEWOOD CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1717
Practice Address - Country:US
Practice Address - Phone:567-303-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130326IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse