Provider Demographics
NPI:1285210708
Name:REAY, AMELIA (CPP, LNA)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:REAY
Suffix:
Gender:F
Credentials:CPP, LNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 S 51ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1789
Mailing Address - Country:US
Mailing Address - Phone:480-912-1199
Mailing Address - Fax:
Practice Address - Street 1:11022 S 51ST ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1789
Practice Address - Country:US
Practice Address - Phone:480-912-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZWB4460146D00000X
AZLNA1000031276164W00000X
AZWB4461251K00000X
AZ26355517261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health