Provider Demographics
NPI:1033588363
Name:REERSLEV, MOUSHUMI-DEVYANI CAMILLE (PA-C)
Entity type:Individual
Prefix:
First Name:MOUSHUMI-DEVYANI
Middle Name:CAMILLE
Last Name:REERSLEV
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:702-838-1456
Practice Address - Street 1:2830 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7397
Practice Address - Country:US
Practice Address - Phone:541-686-9000
Practice Address - Fax:541-242-4585
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA172342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant