MEDICARE: TONYA REESE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN.144136-M-IV	OH

General Provider Information

NPI Number	:	1376973925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA REESE LPN

Provider Business Mailing Address
First Line	:	2537 FERGUSON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2426
Country	:	US
Telephone Number	:	513-283-4625
Fax Number	:	513-347-3668

Provider Business Practice Location Address
First Line	:	2537 FERGUSON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2426
Country	:	US
Telephone Number	:	513-283-4625
Fax Number	:	513-347-3668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	11/19/2013

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