Provider Demographics
NPI:1265602338
Name:REIS, KATHY A (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:A
Last Name:REIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HILDRETH LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1768
Mailing Address - Country:US
Mailing Address - Phone:740-568-0722
Mailing Address - Fax:740-568-1772
Practice Address - Street 1:701 HILDRETH LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1768
Practice Address - Country:US
Practice Address - Phone:740-568-0722
Practice Address - Fax:740-568-1772
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV045178163WD0400X
OH339978163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011145OtherUNISYS