Provider Demographics
NPI:1104675842
Name:REISING, DEANNA LYNNE (PHD, RN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNNE
Last Name:REISING
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:LYNNE
Other - Last Name:YELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3745 E CLEVE BUTCHER CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9332
Mailing Address - Country:US
Mailing Address - Phone:812-320-6705
Mailing Address - Fax:
Practice Address - Street 1:3745 E CLEVE BUTCHER CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-9332
Practice Address - Country:US
Practice Address - Phone:812-320-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28097386A364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical