Provider Demographics
NPI:1376583674
Name:REIS, JOSEPH WAYNE (APNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WAYNE
Last Name:REIS
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6129
Mailing Address - Country:US
Mailing Address - Phone:360-457-0431
Mailing Address - Fax:360-565-3905
Practice Address - Street 1:118 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6129
Practice Address - Country:US
Practice Address - Phone:360-457-0431
Practice Address - Fax:360-565-3905
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003048C363LA2200X, 363LP0808X
WV67233363LA2200X, 363LP0808X
WI3850363L00000X, 363LP0808X
WAAP30006444364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner