Provider Demographics
NPI:1780125708
Name:REYES, KASSI BROOKE (RN)
Entity type:Individual
Prefix:
First Name:KASSI
Middle Name:BROOKE
Last Name:REYES
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 1:1343 CLIFTON ST NW
Mailing Address - Street 2:APT 204
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-7033
Mailing Address - Country:US
Mailing Address - Phone:202-817-7470
Mailing Address - Fax:
Practice Address - Street 1:1343 CLIFTON ST NW
Practice Address - Street 2:APT 204
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7033
Practice Address - Country:US
Practice Address - Phone:202-817-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1035034163W00000X
MERN52511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRN1035034OtherDC BOARD OF NURSING
MERN52511OtherMAINE BOARD OF NURSING