Provider Demographics
NPI:1710219241
Name:REYKA, LADONNA DARLENE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LADONNA
Middle Name:DARLENE
Last Name:REYKA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2638
Mailing Address - Country:US
Mailing Address - Phone:541-882-4691
Mailing Address - Fax:541-883-5211
Practice Address - Street 1:1905 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2638
Practice Address - Country:US
Practice Address - Phone:541-882-4691
Practice Address - Fax:541-883-5211
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201701489NP-PP363LF0000X
TX790601363LF0000X
NVAPN # 001308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ935700Medicaid