Provider Demographics
NPI:1447509468
Name:REESE, JACQUELINE DENISE (RN/MHT)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:DENISE
Last Name:REESE
Suffix:
Gender:F
Credentials:RN/MHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 BROMWICK DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1913
Mailing Address - Country:US
Mailing Address - Phone:937-389-9008
Mailing Address - Fax:
Practice Address - Street 1:5471 BROMWICK DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1913
Practice Address - Country:US
Practice Address - Phone:937-389-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH362282163W00000X, 163WC0400X, 163WG0600X, 163WH0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health