Provider Demographics
NPI:1063758100
Name:MOHAMMED, REESHMA S (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:REESHMA
Middle Name:S
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0719
Mailing Address - Country:US
Mailing Address - Phone:509-837-1617
Mailing Address - Fax:509-837-4908
Practice Address - Street 1:355 CHARDONNAY AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-9521
Practice Address - Country:US
Practice Address - Phone:509-781-6366
Practice Address - Fax:509-781-6367
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201603125NP-PP363L00000X, 363LG0600X
OHNP-13808363L00000X
TXAP125593363LF0000X
WAAP70040793363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily