Provider Demographics
NPI:1760656458
Name:REEVES, MARYLYN ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARYLYN
Middle Name:ANN
Last Name:REEVES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 ADRIAN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4121
Mailing Address - Country:US
Mailing Address - Phone:706-667-9730
Mailing Address - Fax:
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:VETERANS ADMINISTRATION MEDICAL CENTER
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6285
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-823-1734
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55798-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse