Provider Demographics
NPI:1417075136
Name:REEVE, WINIFRED A (ANP)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:A
Last Name:REEVE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 43
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0043
Mailing Address - Country:US
Mailing Address - Phone:907-442-7148
Mailing Address - Fax:
Practice Address - Street 1:436 5TH & TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0043
Practice Address - Country:US
Practice Address - Phone:907-442-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5806163W00000X
AK157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP5745Medicaid
AKTEZ042Medicare PIN
AKP60769Medicare UPIN
AK8EZ52HMedicare ID - Type Unspecified
AKNP5745Medicaid