Provider Demographics
NPI:1376985366
Name:NEOGI, REENA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:NEOGI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:325 9TH AVE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:206-744-8661
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359798
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-3462
Practice Address - Fax:206-744-8661
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60391298163W00000X
WAAP60509677363LF0000X, 363LF0000X
NY338632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1376985366Medicaid
WA1376985366Medicaid