1821082397 NPI number — DR. DAWN R REESE PH.D.

Table of content: DR. DAWN R REESE PH.D. (NPI 1821082397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821082397 NPI number — DR. DAWN R REESE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REESE
Provider First Name:
DAWN
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821082397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1632 SE 6TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33990-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-660-9656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LRMC
Provider Second Line Business Practice Location Address:
MUNSON CIRCLE 3765
Provider Business Practice Location Address City Name:
LANDSTUHL
Provider Business Practice Location Address State Name:
APO
Provider Business Practice Location Address Postal Code:
09180
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
314-590-4619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY10508 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 486705 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 230597 . This is a "MHN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 461293 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 007714068 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 798985 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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