Individual
ANGELA REAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1007 LINCOLNWAY, LA PORTE, IN 46350-3201
(219) 326-2397
Mailing address
1007 LINCOLNWAY, LA PORTE, IN 46350-3201
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
06002633A
IN
Other
Enumeration date
07/02/2007
Last updated
07/08/2007
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