Provider Demographics
NPI:1518493600
Name:REYES, IRINA (RN)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:REYES
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 1:9707 4TH AVE
Mailing Address - Street 2:APT. 4N
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1046
Mailing Address - Country:US
Mailing Address - Phone:917-608-0948
Mailing Address - Fax:
Practice Address - Street 1:9707 4TH AVE
Practice Address - Street 2:APT. 4N
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1046
Practice Address - Country:US
Practice Address - Phone:917-608-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse