Provider Demographics
NPI:1922516384
Name:REESE, CYNTHIA CLAIR
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CLAIR
Last Name:REESE
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 1:16176 ASHTON
Mailing Address - Street 2:
Mailing Address - City:DET.
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-663-0615
Mailing Address - Fax:
Practice Address - Street 1:22625 GLENDALE
Practice Address - Street 2:
Practice Address - City:DET
Practice Address - State:MI
Practice Address - Zip Code:48223
Practice Address - Country:US
Practice Address - Phone:313-472-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820388036376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator