Provider Demographics
NPI:1144400821
Name:REAVES, SAMIECKA SANQUICE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SAMIECKA
Middle Name:SANQUICE
Last Name:REAVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MIKKI
Other - Middle Name:
Other - Last Name:REAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4371 LANDMARK RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-8944
Mailing Address - Country:US
Mailing Address - Phone:614-835-0243
Mailing Address - Fax:
Practice Address - Street 1:4371 LANDMARK RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-8944
Practice Address - Country:US
Practice Address - Phone:614-835-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.112807164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse