Provider Demographics
NPI:1356595250
Name:REYES, MICHAELA CHRISTINE (CNP)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:CHRISTINE
Last Name:REYES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 TERRA DOLCE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1365
Mailing Address - Country:US
Mailing Address - Phone:505-681-8184
Mailing Address - Fax:
Practice Address - Street 1:3846 MASTHEAD ST NE
Practice Address - Street 2:BLDG. C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4479
Practice Address - Country:US
Practice Address - Phone:505-798-9300
Practice Address - Fax:505-798-0808
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR45899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily