Provider Demographics
NPI:1396043345
Name:REEVES-WILBURN, MILDRED SHEREE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:SHEREE
Last Name:REEVES-WILBURN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9139 W CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3411
Mailing Address - Country:US
Mailing Address - Phone:414-243-6684
Mailing Address - Fax:
Practice Address - Street 1:9139 W CUSTER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3411
Practice Address - Country:US
Practice Address - Phone:414-243-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30053-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse