Provider Demographics
NPI:1235468901
Name:REYES, KATHY L (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:L
Last Name:REYES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:KLAFETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-0936
Mailing Address - Country:US
Mailing Address - Phone:708-747-4000
Mailing Address - Fax:708-503-3806
Practice Address - Street 1:333 NORTH MADISON STREET
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8200
Practice Address - Country:US
Practice Address - Phone:708-747-4000
Practice Address - Fax:708-503-3806
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007902367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered