Most Relevant Information
Provider Data
| NPI Number: | 1003438953 |
| Provider Name: | REA PAVATE |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/14/2020 |
| Last Updated: | 08/19/2023 |
Provider Practice Location
550 S JACKSON ST BLDG A3R40
LOUISVILLE
KY
402021622
Practice Location Phone/Fax
| Phone: | 5028522840 |
| Fax: |
Provider Mailing Location
550 S JACKSON ST BLDG A3R40
LOUISVILLE
KY
402021622
Provider Mailing Phone/Fax
| Phone: | 5028522840 |
| Fax: |