Provider Demographics
NPI:1578996740
Name:REESE, REVA GAY (FNP)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:GAY
Last Name:REESE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1414 N VERCLER RD
Mailing Address - Street 2:BLDG 5
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1092
Mailing Address - Country:US
Mailing Address - Phone:509-385-0302
Mailing Address - Fax:509-385-0304
Practice Address - Street 1:1686 W RIVERSTONE DR STE 1
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5779
Practice Address - Country:US
Practice Address - Phone:208-765-4807
Practice Address - Fax:866-573-0853
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60331559363LF0000X
IDNP-1251A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily