Provider Demographics
NPI:1982126231
Name:REEVES, MONA R (RN)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:R
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 1:20725 LEMARSH ST UNIT G
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-7351
Mailing Address - Country:US
Mailing Address - Phone:1817-937-5959
Mailing Address - Fax:
Practice Address - Street 1:20725 LEMARSH ST UNIT G
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-7351
Practice Address - Country:US
Practice Address - Phone:817-937-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse