Healthcare Provider Details

I. General information

NPI: 1699427120
Provider Name (Legal Business Name): CHEMENE DIONNE REYLICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHEMENE COLLICK

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N LEE TREVINO DR
EL PASO TX
79936-2098
US

IV. Provider business mailing address

3100 N LEE TREVINO DR
EL PASO TX
79936-2098
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-7465
  • Fax:
Mailing address:
  • Phone: 915-533-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: