Basic Information
Provider Information
NPI: 1164546131
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REEVES
FirstName: ROXY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: REEVES
OtherFirstName: ROXANNE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: CNM
OtherLastNameType: 5
Mailing Information
Address1: 311 KALANIANAOLE AVE
Address2:  
City: HILO
State: HI
PostalCode: 967204740
CountryCode: US
TelephoneNumber: 8089691427
FaxNumber: 8089615167
Practice Location
Address1: 311 KALANIANAOLE AVE
Address2:  
City: HILO
State: HI
PostalCode: 967204740
CountryCode: US
TelephoneNumber: 8089691427
FaxNumber: 8089615167
Other Information
ProviderEnumerationDate: 03/16/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X353102CAX Nursing Service ProvidersRegistered Nurse 
163W00000XRN 56928HIX Nursing Service ProvidersRegistered Nurse 
363L00000X4886CAX Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363L00000XAPRN 910HIX Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
367A00000XCNM 749CAX Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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