Provider Demographics
NPI:1942045190
Name:REEVEY, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:REEVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD STE 455
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3740
Mailing Address - Country:US
Mailing Address - Phone:248-805-3511
Mailing Address - Fax:
Practice Address - Street 1:23077 GREENFIELD RD STE 455
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3740
Practice Address - Country:US
Practice Address - Phone:248-805-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty