Healthcare Provider Details

I. General information

NPI: 1871859934
Provider Name (Legal Business Name): SHONDRA NICOLE REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LAKE FOREST DR
MOUNT JULIET TN
37122-1345
US

IV. Provider business mailing address

15 LAKE FOREST DR
MOUNT JULIET TN
37122-1345
US

V. Phone/Fax

Practice location:
  • Phone: 615-554-6400
  • Fax:
Mailing address:
  • Phone: 615-554-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: