Healthcare Provider Details

I. General information

NPI: 1568080067
Provider Name (Legal Business Name): WENDY A. REISS, PMHNP - BC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 EAST CENTER STREET,
NAZARETH PA
18064-2254
US

IV. Provider business mailing address

5982 KESSLERSVILLE ROAD
NAZARETH PA
18064-9374
US

V. Phone/Fax

Practice location:
  • Phone: 908-386-5112
  • Fax: 570-402-1144
Mailing address:
  • Phone: 908-386-5112
  • Fax: 570-402-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WENDY A. REISS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 908-386-5112