Provider Demographics
NPI:1477727998
Name:REEVES, MERRILYN R (LM, CPM)
Entity Type:Individual
Prefix:
First Name:MERRILYN
Middle Name:R
Last Name:REEVES
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HAYNES LN
Mailing Address - Street 2:
Mailing Address - City:PLUMMER
Mailing Address - State:ID
Mailing Address - Zip Code:83851-9618
Mailing Address - Country:US
Mailing Address - Phone:208-686-1041
Mailing Address - Fax:
Practice Address - Street 1:101 HAYNES LN
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851-9618
Practice Address - Country:US
Practice Address - Phone:208-686-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-13176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1477727998Medicaid