Individual
MARY ELLEN REAVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, APRN, FNP-BC
Contact information
Practice address
140 WATER ST, RED BANK, NJ 07701-1100
(732) 747-3727
Mailing address
140 WATER STREET, RED BANK, NJ 07701
(732) 747-3727
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00381400
NJ
363LF0000X
Family Nurse Practitioner
F337177-1
NY
Other
Enumeration date
02/08/2016
Last updated
05/26/2017
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