Provider Demographics
NPI:1174988422
Name:NORTHRUP, REVE K (CNA/CMA)
Entity type:Individual
Prefix:MS
First Name:REVE
Middle Name:K
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:CNA/CMA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-1110
Mailing Address - Fax:877-874-1031
Practice Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:877-874-1031
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA00194215376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide