Provider Demographics
NPI:1134339435
Name:REEVES, SHAWNA (PA-C)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 CROSSFIRE DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-1777
Mailing Address - Country:US
Mailing Address - Phone:970-568-7814
Mailing Address - Fax:
Practice Address - Street 1:2200 O ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9503
Practice Address - Country:US
Practice Address - Phone:970-304-6235
Practice Address - Fax:970-304-6241
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant