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General NPI Number Information
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NPI Number | 1700132701
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Entity Type | Individual
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Provider Name | GEORGIA LUCILLE REYES BACHELORS
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Gender | Female
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 500 HANCOCK ST
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City | SAGINAW
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State | MI
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Zip | 48602-4224
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Country | US
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Telephone | 989-797-3477
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Fax | 989-797-3477
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Provider Business Mailing Address
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Address Line | 11200 LADYSLIPPER LN
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City | SAGINAW
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State | MI
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Zip | 48609-8827
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Country | US
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Telephone | 989-860-8148
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 172V00000X
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License Number State | MI
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