Provider Demographics
NPI:1629681002
Name:REAVES, SYREETA WATKINS (RN)
Entity Type:Individual
Prefix:MRS
First Name:SYREETA
Middle Name:WATKINS
Last Name:REAVES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SYREETA
Other - Middle Name:SCHIFFON
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1016 BLUE SKY DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7970
Mailing Address - Country:US
Mailing Address - Phone:910-352-2023
Mailing Address - Fax:
Practice Address - Street 1:1016 BLUE SKY DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7970
Practice Address - Country:US
Practice Address - Phone:910-352-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC233078163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse