Provider Demographics
NPI:1588746630
Name:REEVES, NEDRA (CNM)
Entity type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-232-1818
Mailing Address - Fax:630-232-1868
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:STE 202
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-232-1818
Practice Address - Fax:630-232-1868
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41191396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant