Provider Demographics
NPI:1710260344
Name:REASE, MICHELLE L (GRNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:REASE
Suffix:
Gender:F
Credentials:GRNA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:GETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:40 FRONT ST. SUITE C
Mailing Address - Street 2:C/O RIVERSIDE ANESTHESIA
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-722-7264
Mailing Address - Fax:607-722-7869
Practice Address - Street 1:40 FRONT ST. SUITE C
Practice Address - Street 2:C/O RIVERSIDE ANESTHESIA
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-722-7264
Practice Address - Fax:607-722-7869
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648071163W00000X
PA088813367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse