Provider Demographics
NPI:1912637281
Name:REYES, THALIA (CRNA)
Entity type:Individual
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First Name:THALIA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-2526
Mailing Address - Fax:207-662-6236
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2526
Practice Address - Fax:207-662-6236
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2025-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY707151163WC0200X
MERNA253053367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine