Healthcare Provider Details

I. General information

NPI: 1417075136
Provider Name (Legal Business Name): WINIFRED A REEVE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 5TH & TED STEVENS WAY
KOTZEBUE AK
99752-0043
US

IV. Provider business mailing address

P.O. BOX 43
KOTZEBUE AK
99752-0043
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-7148
  • Fax:
Mailing address:
  • Phone: 907-442-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number157
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5806
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: