Provider Demographics
NPI:1679518138
Name:REESE, ROSHANN RENE
Entity Type:Individual
Prefix:MS
First Name:ROSHANN
Middle Name:RENE
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4839
Mailing Address - Country:US
Mailing Address - Phone:626-676-4168
Mailing Address - Fax:626-507-8148
Practice Address - Street 1:191 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4839
Practice Address - Country:US
Practice Address - Phone:626-676-4168
Practice Address - Fax:626-507-8148
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566078163WH0200X, 163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health