Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 1016323 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209003969 | IL |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5182 | WI |
NPI | 1134498082 |
---|---|
Provider Name | Freddie Reed - Davis |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2011 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134498082 | (05) | WI |