Provider Demographics
NPI:1730155433
Name:REASONOVER, ROBERT DAVID (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:REASONOVER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SEVENTH ST SE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-340-0012
Mailing Address - Fax:256-340-1408
Practice Address - Street 1:1215 SEVENTH ST SE
Practice Address - Street 2:SUITE 220
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601
Practice Address - Country:US
Practice Address - Phone:256-340-0012
Practice Address - Fax:256-340-1408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-073350363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner