Healthcare Provider Details

I. General information

NPI: 1982979084
Provider Name (Legal Business Name): SHARON LOUISE REARDON REEVES MN,BSN,APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PARK AVE SW STE 100
AIKEN SC
29801-2417
US

IV. Provider business mailing address

118 PARK AVE SW STE 100
AIKEN SC
29801-2417
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-0049
  • Fax: 803-641-0810
Mailing address:
  • Phone: 803-641-0049
  • Fax: 803-641-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN1628
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: