Basic Information
Provider Information
NPI: 1659908366
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REES
FirstName: ANNA
MiddleName: KATHERINE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7324 BERYL ST
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701242509
CountryCode: US
TelephoneNumber: 5049190154
FaxNumber:  
Practice Location
Address1: 1000 BLYTHE BLVD
Address2: 4TH FLOOR MEB
City: CHARLOTTE
State: NC
PostalCode: 282035812
CountryCode: US
TelephoneNumber: 7043816800
FaxNumber: 7043816841
Other Information
ProviderEnumerationDate: 03/24/2020
LastUpdateDate: 03/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X260720NCY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home