Individual
MICHELE EVANS-REAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
13551 WATERFORD PL, MIDLOTHIAN, VA 23112-3929
(804) 320-4243
(804) 622-0552
Mailing address
1000 BOULDERS PKWY, SUITE 102, NORTH CHESTERFIELD, VA 23225-5545
(804) 320-4243
(804) 622-0552
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024171909
VA
363LA2200X
Adult Health Nurse Practitioner
26NJ00439500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
01/13/2014
Last updated
08/24/2022
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