Provider Demographics
NPI:1689965022
Name:REESE, TINA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:REESE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SHENANDOAH CT
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-1536
Mailing Address - Country:US
Mailing Address - Phone:717-577-8085
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA281228164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse