Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1028999 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 3013945 | KY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 4704258002 | MI |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 71002375A | IN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN.CNP.026658 | OH |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1028999 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | 3013945 | KY |
N | 363LG0600X | Nurse Practitioner - Gerontology | 4704258002 | MI |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 71002375A | IN |
N | 363LG0600X | Nurse Practitioner - Gerontology | APRN.CNP.026658 | OH |
NPI | 1023059573 |
---|---|
Provider Name | Anita D Reid |
First Address | Fort Wayne, IN 46851-0299 |
Second Address | Crown Point, IN 46307-1877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S57083 | (02) | NH |