Individual
MS. DIVINA COLLEEN REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 N SENATE BLVD, ROOM AG001, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 962-8652
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
71002749
IN
363LF0000X
Family Nurse Practitioner
Primary
71002749A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200925780
—
IN
Enumeration date
10/19/2008
Last updated
02/01/2021
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