Provider Demographics
NPI:1235466038
Name:REESE, GLADYS SHAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:SHAN
Last Name:REESE
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 1:6066 WILDWOOD LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9793
Mailing Address - Country:US
Mailing Address - Phone:715-369-0311
Mailing Address - Fax:
Practice Address - Street 1:6066 WILDWOOD LAKE CIR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-9793
Practice Address - Country:US
Practice Address - Phone:715-369-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI83990-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38325806Medicaid