Provider Demographics
NPI:1508465600
Name:REISNER, REBEKKAH CASI (RN)
Entity Type:Individual
Prefix:
First Name:REBEKKAH
Middle Name:CASI
Last Name:REISNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 UNDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2853
Mailing Address - Country:US
Mailing Address - Phone:937-409-9249
Mailing Address - Fax:
Practice Address - Street 1:5312 UNDERWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:OH
Practice Address - Zip Code:45431-2853
Practice Address - Country:US
Practice Address - Phone:937-409-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0084464251E00000X
OHRN.438724163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251E00000XAgenciesHome Health