Provider Demographics
NPI:1821405879
Name:REEVES, PAMELA M (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
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 1:814 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1380
Mailing Address - Country:US
Mailing Address - Phone:248-420-5944
Mailing Address - Fax:248-276-9704
Practice Address - Street 1:2992 CEDAR KEY DR
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1508
Practice Address - Country:US
Practice Address - Phone:248-420-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704305706163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse