Provider Demographics
NPI:1669947438
Name:REEVES, JERELYN RENAE (LPN)
Entity type:Individual
Prefix:MS
First Name:JERELYN
Middle Name:RENAE
Last Name:REEVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 CHENANGO ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-2061
Mailing Address - Country:US
Mailing Address - Phone:607-349-5841
Mailing Address - Fax:
Practice Address - Street 1:649 CHENANGO ST APT 1
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-2061
Practice Address - Country:US
Practice Address - Phone:607-349-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330068-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse