Basic Information
| Provider Information | |||||||||
| NPI: | 1669129284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNA | ||||||||
| FirstName: | ARRIANA | ||||||||
| MiddleName: | ELYSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9021 1ST LN SE # APTG202 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985131515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546819922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1570 WILMINGTON DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983278773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064534882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2022 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.