Individual
MR. JACK EDWARD REEVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3309 WILDWOOD LN, WAUSAU, WI 54401-4094
(630) 886-0222
Mailing address
3309 WILDWOOD LN, WAUSAU, WI 54401-4094
(630) 886-0222
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35040400
—
WI
Enumeration date
11/02/2007
Last updated
11/02/2007
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