Provider Demographics
NPI:1124844402
Name:REESE, TEHESHA L
Entity type:Individual
Prefix:
First Name:TEHESHA
Middle Name:L
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17249 SHADOAN WAY
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8809
Mailing Address - Country:US
Mailing Address - Phone:317-490-2629
Mailing Address - Fax:
Practice Address - Street 1:17249 SHADOAN WAY
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8809
Practice Address - Country:US
Practice Address - Phone:317-490-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27073761A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse