Provider Demographics
NPI:1871180554
Name:REILLY, NANCY (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:REILLY
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 1:2338 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4025
Mailing Address - Country:US
Mailing Address - Phone:646-369-7441
Mailing Address - Fax:
Practice Address - Street 1:2338 AMHERST ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4025
Practice Address - Country:US
Practice Address - Phone:646-369-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse