Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD153328 | OR |
N | 207N00000X | Dermatologist | MD60215670 | WA |
N | 207NS0135X | Procedural Dermatology | MD153328 | OR |
N | 207NS0135X | Procedural Dermatology | MD60215670 | WA |
NPI | 1285891168 |
---|---|
Provider Name | Stacy Nicole Reed |
First Address | Portland, OR 97229-5987 |
Second Address | Portland, OR 97229-5987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 01/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285891168 | (02) | OR |
500646390 | (05) | OR |