Provider Demographics
NPI:1891278396
Name:REEL, MARLAINA FELICE
Entity Type:Individual
Prefix:
First Name:MARLAINA
Middle Name:FELICE
Last Name:REEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-4858
Mailing Address - Country:US
Mailing Address - Phone:618-660-6505
Mailing Address - Fax:618-236-2873
Practice Address - Street 1:1400 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-4858
Practice Address - Country:US
Practice Address - Phone:618-660-6505
Practice Address - Fax:618-236-2873
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.297506163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1467590166Medicaid