Provider Demographics
NPI:1952995995
Name:REECE, TINA MARIE (IBCLC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:REECE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 KIRK ROW
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3980
Mailing Address - Country:US
Mailing Address - Phone:317-614-5177
Mailing Address - Fax:
Practice Address - Street 1:1508 KIRK ROW
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3980
Practice Address - Country:US
Practice Address - Phone:317-614-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INL-313409174N00000X
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN