Basic Information
| Provider Information | |||||||||
| NPI: | 1013912179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELAND-REEVES | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1075 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451239780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379819444 | ||||||||
| FaxNumber: | 9379819448 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379819444 | ||||||||
| FaxNumber: | 9379819448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-082754 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 3582754 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2422597 | 05 | OH | MEDICAID |