Healthcare Provider Details

I. General information

NPI: 1114391786
Provider Name (Legal Business Name): NINA REISS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N. 1ST ST.
YAKIMA WA
98901
US

IV. Provider business mailing address

306 N 31ST AVE
YAKIMA WA
98902-2336
US

V. Phone/Fax

Practice location:
  • Phone: 509-853-4327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60894976
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00169288
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: