Provider Demographics
NPI:1689917213
Name:REEVES, CAROL SUE (CNM)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUE
Last Name:REEVES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 GREENFIELD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3500
Mailing Address - Country:US
Mailing Address - Phone:559-584-0141
Mailing Address - Fax:559-584-5711
Practice Address - Street 1:460 GREENFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3500
Practice Address - Country:US
Practice Address - Phone:559-584-0141
Practice Address - Fax:559-584-5711
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3358163W00000X, 363LX0001X
CA130176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology