Healthcare Provider Details

I. General information

NPI: 1093171126
Provider Name (Legal Business Name): OLIVIA REEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

105 DRAYMORE WAY
CARY NC
27519-8677
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-6193
  • Fax: 919-477-1931
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number108670
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: