Provider Demographics
NPI:1487902490
Name:REYES, THERESE ANNE (RN, MSN, APN/CNS)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:ANNE
Last Name:REYES
Suffix:
Gender:F
Credentials:RN, MSN, APN/CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60436-2502
Mailing Address - Country:US
Mailing Address - Phone:815-514-8316
Mailing Address - Fax:
Practice Address - Street 1:500 WILCOX ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6169
Practice Address - Country:US
Practice Address - Phone:815-740-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004696163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development