Provider Demographics
NPI:1720721426
Name:REYES, ILONA D (LPN)
Entity Type:Individual
Prefix:MS
First Name:ILONA
Middle Name:D
Last Name:REYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ILONA
Other - Middle Name:D
Other - Last Name:FONTANILLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3313 WHISPERING HLS
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1532
Mailing Address - Country:US
Mailing Address - Phone:845-469-9036
Mailing Address - Fax:845-469-9036
Practice Address - Street 1:3313 WHISPERING HLS
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1532
Practice Address - Country:US
Practice Address - Phone:845-469-9036
Practice Address - Fax:845-469-9036
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160915-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse