Provider Demographics
NPI:1578861266
Name:REISZ, MARTHA (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:REISZ
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 1:18377 MENNELL RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9813
Mailing Address - Country:US
Mailing Address - Phone:440-668-4155
Mailing Address - Fax:
Practice Address - Street 1:18377 MENNELL RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-9813
Practice Address - Country:US
Practice Address - Phone:440-668-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH331008163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice