Provider Demographics
NPI:1619913274
Name:REESE, JOHN L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:REESE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 AIRPORT CENTER PKWY BLDG L
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5885
Mailing Address - Country:US
Mailing Address - Phone:704-512-7105
Mailing Address - Fax:
Practice Address - Street 1:433 MCALISTER RD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4147
Practice Address - Country:US
Practice Address - Phone:980-212-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43744367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000175Medicaid
NC8000175Medicaid