Provider Demographics
NPI:1891405924
Name:REASONER, TINA JEAN
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:JEAN
Last Name:REASONER
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 1:3845 KIRKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1129
Mailing Address - Country:US
Mailing Address - Phone:517-513-0632
Mailing Address - Fax:
Practice Address - Street 1:3845 KIRKWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1129
Practice Address - Country:US
Practice Address - Phone:517-513-0632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach