Provider Demographics
NPI:1093332843
Name:REUBEN, LAURENCE STEPHEN (RN)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:STEPHEN
Last Name:REUBEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26070 RADCLIFT PL
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1047
Mailing Address - Country:US
Mailing Address - Phone:248-417-2240
Mailing Address - Fax:
Practice Address - Street 1:26070 RADCLIFT PL
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1047
Practice Address - Country:US
Practice Address - Phone:248-417-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704315893163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health