Healthcare Provider Details

I. General information

NPI: 1396798187
Provider Name (Legal Business Name): CYNTHIIA ANN REESE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N LAFAYETTE BLVD
SOUTH BEND IN
46601-1003
US

IV. Provider business mailing address

515 N LAFAYETTE BLVD
SOUTH BEND IN
46601-1003
US

V. Phone/Fax

Practice location:
  • Phone: 574-232-2037
  • Fax: 574-232-1420
Mailing address:
  • Phone: 574-232-2037
  • Fax: 574-232-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71000078A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: