1992000954 NPI number — MRS. DARLENE L. REAKA ISRAEL MSN, CRNP

Table of content: MRS. DARLENE L. REAKA ISRAEL MSN, CRNP (NPI 1992000954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992000954 NPI number — MRS. DARLENE L. REAKA ISRAEL MSN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REAKA ISRAEL
Provider First Name:
DARLENE
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REAKA
Provider Other First Name:
DARLENE
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992000954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 CHARTLEY PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REISTERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-833-2949
Provider Business Mailing Address Fax Number:
410-833-3136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 CHARTLEY PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-833-2949
Provider Business Practice Location Address Fax Number:
410-833-3136
Provider Enumeration Date:
01/21/2011

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: 363LP0200X , with the licence number:  R116499 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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