Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 71011219A | IN |
NPI | 1174192421 |
---|---|
Provider Name | Douglas S Reed |
First Address | Columbia City, IN 46725-1710 |
Second Address | Fort Wayne, IN 46825-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 22/06/2021 |