Provider Demographics
NPI:1659395796
Name:REISS, ELEANORE (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:ELEANORE
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 SILVER HILL CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2411
Mailing Address - Country:US
Mailing Address - Phone:770-879-0780
Mailing Address - Fax:
Practice Address - Street 1:4153 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE 5
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2854
Practice Address - Country:US
Practice Address - Phone:770-935-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN070451 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily