Provider Demographics
NPI:1235707753
Name:REISSIG, JILLIAN (IN-HWC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:REISSIG
Suffix:
Gender:F
Credentials:IN-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29607 FOLIAGE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5245
Mailing Address - Country:US
Mailing Address - Phone:832-560-4110
Mailing Address - Fax:
Practice Address - Street 1:333 WEST LOOP N STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-7767
Practice Address - Country:US
Practice Address - Phone:713-690-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date: