Provider Demographics
NPI:1184101248
Name:REAVES-TAYLOR, JESSIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:
Last Name:REAVES-TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3187
Mailing Address - Country:US
Mailing Address - Phone:908-787-5574
Mailing Address - Fax:
Practice Address - Street 1:382 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3187
Practice Address - Country:US
Practice Address - Phone:908-787-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN281812164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse