MEDICARE: MS. CECILY DIAN REEVES FNP, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	257818	CA

General Provider Information

NPI Number	:	1669685863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CECILY DIAN REEVES FNP, PHD

Provider Business Mailing Address
First Line	:	613 BLACKSTONE DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-1354
Country	:	US
Telephone Number	:	415-492-8072
Fax Number	:	415-479-7149

Provider Business Practice Location Address
First Line	:	3100 SUMMIT ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-3412
Country	:	US
Telephone Number	:	415-686-1115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	11/12/2014

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