Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95003071 | CA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN161484 | GA |
NPI | 1053757211 |
---|---|
Provider Name | Jamie Reeder |
First Address | San Jose, CA 95126-2203 |
Second Address | Seaside, CA 93955-5720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 08/09/2016 |