Provider Demographics
NPI:1386067973
Name:KLAR, REVA (RN)
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:
Last Name:KLAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:REVA
Other - Middle Name:
Other - Last Name:KLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1074 ABBEY ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5677
Mailing Address - Country:US
Mailing Address - Phone:248-217-8356
Mailing Address - Fax:
Practice Address - Street 1:882 OAKMAN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3710
Practice Address - Country:US
Practice Address - Phone:313-961-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119149163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse