Provider Demographics
NPI:1952827909
Name:REID, EVELYN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866-0282
Mailing Address - Country:US
Mailing Address - Phone:480-580-4434
Mailing Address - Fax:
Practice Address - Street 1:7316 HOLLOMAN DR
Practice Address - Street 2:
Practice Address - City:IVOR
Practice Address - State:VA
Practice Address - Zip Code:23866
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver