Provider Demographics
NPI:1871859934
Name:REESE, SHONDRA NICOLE
Entity type:Individual
Prefix:
First Name:SHONDRA
Middle Name:NICOLE
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-1345
Mailing Address - Country:US
Mailing Address - Phone:615-554-6400
Mailing Address - Fax:
Practice Address - Street 1:15 LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-1345
Practice Address - Country:US
Practice Address - Phone:615-554-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy