Healthcare Provider Details

I. General information

NPI: 1558731919
Provider Name (Legal Business Name): MATTHEW P REESE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 S I 10 SERVICE RD W STE 100
METAIRIE LA
70001-1884
US

IV. Provider business mailing address

2637 EDENBORN AVE STE 302
METAIRIE LA
70002-7042
US

V. Phone/Fax

Practice location:
  • Phone: 504-838-5257
  • Fax:
Mailing address:
  • Phone: 504-579-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number226873
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number149101
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: