Healthcare Provider Details

I. General information

NPI: 1780125708
Provider Name (Legal Business Name): KASSI BROOKE REYES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 CLIFTON ST NW APT 204
WASHINGTON DC
20009-7033
US

IV. Provider business mailing address

1343 CLIFTON ST NW APT 204
WASHINGTON DC
20009-7033
US

V. Phone/Fax

Practice location:
  • Phone: 202-817-7470
  • Fax:
Mailing address:
  • Phone: 202-817-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1035034
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN52511
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: