Healthcare Provider Details

I. General information

NPI: 1528984010
Provider Name (Legal Business Name): ISAIAH MATTHEW REEVES LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W 9TH ST
GEORGETOWN IL
61846-1419
US

IV. Provider business mailing address

2114 SMITH AVE APT 1
DANVILLE IL
61832-1591
US

V. Phone/Fax

Practice location:
  • Phone: 217-918-8759
  • Fax:
Mailing address:
  • Phone: 217-655-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043.616029
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: