Provider Demographics
NPI:1700422292
Name:REEVES, THELMA I
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:I
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 BLAKLEY RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NY
Mailing Address - Zip Code:13071
Mailing Address - Country:US
Mailing Address - Phone:315-283-7405
Mailing Address - Fax:
Practice Address - Street 1:3027 BLAKLEY RD
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NY
Practice Address - Zip Code:13071
Practice Address - Country:US
Practice Address - Phone:315-283-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider