Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN195497 | GA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN195497 | GA |
NPI | 1073999132 |
---|---|
Provider Name | Ms. Courtney Reeves |
First Address | Minnetonka, MN 55343-9664 |
Second Address | Macon, GA 31206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 23/09/2020 |