Healthcare Provider Details

I. General information

NPI: 1992341374
Provider Name (Legal Business Name): CRISTINA BONNER REAVES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 06/28/2023
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

V. Phone/Fax

Practice location:
  • Phone: 205-801-8279
  • Fax:
Mailing address:
  • Phone: 205-801-8146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-142261
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-142261
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-142261
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: