Healthcare Provider Details

I. General information

NPI: 1497928915
Provider Name (Legal Business Name): LENYA REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

1494 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-7276
  • Fax:
Mailing address:
  • Phone: 505-983-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number90021R
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number83-PA-0132
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: