Provider Demographics
NPI:1255143335
Name:REANO, IRIS (CHW)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:REANO
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LONE MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEWA
Mailing Address - State:NM
Mailing Address - Zip Code:87052-9603
Mailing Address - Country:US
Mailing Address - Phone:505-274-4003
Mailing Address - Fax:
Practice Address - Street 1:108 LONE MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KEWA
Practice Address - State:NM
Practice Address - Zip Code:87052-9603
Practice Address - Country:US
Practice Address - Phone:505-274-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG-086172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker