Provider Demographics
NPI:1558960153
Name:REANO, RENEA M (CPNP)
Entity Type:Individual
Prefix:
First Name:RENEA
Middle Name:M
Last Name:REANO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 IRVING BLVD NW APT 508
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3906
Mailing Address - Country:US
Mailing Address - Phone:505-916-6162
Mailing Address - Fax:
Practice Address - Street 1:4701 IRVING BLVD NW APT 508
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3906
Practice Address - Country:US
Practice Address - Phone:505-916-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM202018145363LP0200X
NM62681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics