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Individual

MARY L BLAKE REEVES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4626 LEE AVE, SAINT LOUIS, MO 63115-2431
(314) 385-7726
Mailing address
5535 DELMAR BLVD, SAINT LOUIS, MO 63112-3005
(314) 879-6300
(314) 879-6372

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
068911
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11646789
CAQH
MO
01
1710937073
NATIONAL PROVIDER IDENTIFIER
MO
05
427399902
MO
05
815032931
MO
Enumeration date
05/10/2006
Last updated
09/19/2011
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