Provider Demographics
NPI:1073801924
Name:REID, C. DALE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:C.
Middle Name:DALE
Last Name:REID
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 W 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3928
Mailing Address - Country:US
Mailing Address - Phone:303-329-0870
Mailing Address - Fax:303-394-0871
Practice Address - Street 1:6750 W 52ND AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3928
Practice Address - Country:US
Practice Address - Phone:303-329-0870
Practice Address - Fax:303-394-0871
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79179363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
303-462-1523Medicare UPIN