Provider Demographics
NPI:1457598765
Name:REEVES, MICHELLE KRISTEN (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KRISTEN
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 1:41182 HIGHWAY 261
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925-9705
Mailing Address - Country:US
Mailing Address - Phone:928-333-5579
Mailing Address - Fax:
Practice Address - Street 1:41182 HIGHWAY 261
Practice Address - Street 2:
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925-9705
Practice Address - Country:US
Practice Address - Phone:928-333-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN114245163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse