Provider Demographics
NPI:1225511264
Name:REISS, WENDY ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:REISS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5982 KESSLERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NAZAETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9374
Mailing Address - Country:US
Mailing Address - Phone:908-386-5112
Mailing Address - Fax:570-402-1144
Practice Address - Street 1:480 MEMORIAL PARKWAY
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1575
Practice Address - Country:US
Practice Address - Phone:908-386-5112
Practice Address - Fax:570-402-1144
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00856600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner