Individual
REECE PONICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1873 W ENCINAS ST, GILBERT, AZ 85233-2314
(480) 204-7739
Mailing address
1873 W ENCINAS ST, GILBERT, AZ 85233-2314
(480) 204-7739
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN165385
AZ
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
RN165385
AZ
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN165385
AZ
163WP2201X
Ambulatory Care Registered Nurse
RN165385
AZ
Other
Enumeration date
01/19/2019
Last updated
01/19/2019
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