Provider Demographics
NPI:1801042528
Name:JOHN, REENA (APN)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2311
Mailing Address - Country:US
Mailing Address - Phone:702-878-9500
Mailing Address - Fax:702-796-8502
Practice Address - Street 1:5233 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2311
Practice Address - Country:US
Practice Address - Phone:702-878-9500
Practice Address - Fax:702-878-8993
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAX083ZMedicare PIN