Provider Demographics
NPI:1386067023
Name:REYES DE CORRAL, LORENA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:REYES DE CORRAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:REYES-CORRAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:400 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4363
Mailing Address - Country:US
Mailing Address - Phone:702-927-9754
Mailing Address - Fax:702-868-2821
Practice Address - Street 1:400 SHADOW LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4363
Practice Address - Country:US
Practice Address - Phone:702-927-9754
Practice Address - Fax:702-868-2821
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse