Provider Demographics
NPI:1356945166
Name:REAVIS, JOHN MICHAEL (CNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:REAVIS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W GOLD ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2215
Mailing Address - Country:US
Mailing Address - Phone:406-565-0249
Mailing Address - Fax:
Practice Address - Street 1:1001 W GOLD ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2215
Practice Address - Country:US
Practice Address - Phone:406-565-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT361838376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide