Provider Demographics
NPI:1326059940
Name:REESE, VIRGINIA MARY (RN NP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARY
Last Name:REESE
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN NP
Mailing Address - Street 1:19080 ELM DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8984
Mailing Address - Country:US
Mailing Address - Phone:760-247-1877
Mailing Address - Fax:
Practice Address - Street 1:16147 KAMANA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1377
Practice Address - Country:US
Practice Address - Phone:760-946-4730
Practice Address - Fax:760-242-0566
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318126363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology