MEDICARE: CARMEN LATRICE REESE STNA

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1760533665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN LATRICE REESE STNA

Provider Business Mailing Address
First Line	:	16806 LIPTON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-3620
Country	:	US
Telephone Number	:	216-581-6254
Fax Number	:

Provider Business Practice Location Address
First Line	:	16806 LIPTON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-3620
Country	:	US
Telephone Number	:	216-581-6254
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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Directions to “ CARMEN LATRICE REESE STNA” Practice Location

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