Provider Demographics
NPI:1588297675
Name:CASTEEN, REIKO ADELE (CSA, LSA)
Entity type:Individual
Prefix:MRS
First Name:REIKO
Middle Name:ADELE
Last Name:CASTEEN
Suffix:
Gender:F
Credentials:CSA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 KIPPER DR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2221
Mailing Address - Country:US
Mailing Address - Phone:757-636-7856
Mailing Address - Fax:
Practice Address - Street 1:4801 KIPPER DR
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-2221
Practice Address - Country:US
Practice Address - Phone:757-636-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000087246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant