Provider Demographics
NPI:1124330360
Name:REYNA, LOLA DINA (RN MSN FNP)
Entity type:Individual
Prefix:MRS
First Name:LOLA
Middle Name:DINA
Last Name:REYNA
Suffix:
Gender:F
Credentials:RN MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4027
Mailing Address - Country:US
Mailing Address - Phone:361-701-9333
Mailing Address - Fax:
Practice Address - Street 1:1707 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4027
Practice Address - Country:US
Practice Address - Phone:361-701-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-03
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily