Provider Demographics
NPI:1215968862
Name:REESE, SUE ANN (ADVANCED PRACTICE NU)
Entity type:Individual
Prefix:
First Name:SUE ANN
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 CRANBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-3333
Mailing Address - Fax:732-257-5432
Practice Address - Street 1:593 CRANBURY ROAD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-390-3333
Practice Address - Fax:732-257-5432
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN12144600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q14247Medicare UPIN
NH078408AF3Medicare ID - Type Unspecified