Individual
TINA REES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3564 SCOTTSDALE ST, PORTAGE, IN 46368-5420
(219) 763-8112
(219) 764-3251
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-3251
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27056624A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IN
Enumeration date
01/12/2010
Last updated
01/12/2010
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