Provider Demographics
NPI:1407467079
Name:REYES, MICHEL (RN)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MICHEL
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1 PASSAIC CT
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1306
Mailing Address - Country:US
Mailing Address - Phone:201-966-3674
Mailing Address - Fax:
Practice Address - Street 1:1 PASSAIC CT
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1306
Practice Address - Country:US
Practice Address - Phone:201-966-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR21998600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse