Provider Demographics
NPI:1417266495
Name:REAVES-O'NEAL, DANA LYNN (CPNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:REAVES-O'NEAL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 MAIN ST # E1960.41
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2351
Mailing Address - Country:US
Mailing Address - Phone:832-826-5942
Mailing Address - Fax:
Practice Address - Street 1:6651 MAIN STREET
Practice Address - Street 2:SUITE MC-E 1690.41
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2351
Practice Address - Country:US
Practice Address - Phone:832-826-5942
Practice Address - Fax:832-825-9637
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX573344363LP0200X
TXAP119167363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics