Provider Demographics
NPI:1851322408
Name:REISMAN, MICHAEL LEE (FNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:REISMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1151
Mailing Address - Country:US
Mailing Address - Phone:559-733-5583
Mailing Address - Fax:
Practice Address - Street 1:NEVADA HEALTH CENTERS
Practice Address - Street 2:1802 N CARSON STREET SUITE #100
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1227
Practice Address - Country:US
Practice Address - Phone:775-755-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10625363LF0000X
FLARNP1396252363LF0000X
CO109713363LF0000X
NVAPN325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVR64728Medicare UPIN