Individual
JACQUELINE REAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3993 LEATHER STOCKING TRL, COLUMBUS, OH 43230-1528
(614) 806-8647
Mailing address
PO BOX 307514, GAHANNA, OH 43230-7514
(614) 758-7700
(404) 795-7118
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
142153
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84-4156364
—
OH
Enumeration date
01/13/2020
Last updated
01/13/2020
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