Provider Demographics
NPI:1578537205
Name:REESE, CYNTHIA B (BA, MSN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:REESE
Suffix:
Gender:F
Credentials:BA, MSN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:F
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:55 W TIETAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4445
Mailing Address - Country:US
Mailing Address - Phone:509-525-3720
Mailing Address - Fax:509-522-1592
Practice Address - Street 1:320 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2922
Practice Address - Country:US
Practice Address - Phone:509-525-5010
Practice Address - Fax:509-522-9448
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003228367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA165697Medicaid
WA9610056Medicaid
WA165697Medicaid
WA9610056Medicaid