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General NPI Number Information
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NPI Number | 1588759690
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Entity Type | Individual
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Provider Name | MARJORIE ANN REA WHNP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 769 PIPESTONE ST
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City | BENTON HARBOR
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State | MI
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Zip | 49022-4815
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Country | US
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Telephone | 269-684-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 26777 DEERPATH CT
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City | EDWARDSBURG
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State | MI
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Zip | 49112-8683
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Country | US
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Telephone | 269-663-8673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 364SW0102X
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Taxonomy Name | Women's Health Clinical Nurse Specialist
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License Number |
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License Number State | MI
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