Provider Demographics
NPI:1093490005
Name:COMPAGNER, REID
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:COMPAGNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 JOY ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1942
Mailing Address - Country:US
Mailing Address - Phone:616-405-1158
Mailing Address - Fax:
Practice Address - Street 1:MUNSON MEDICAL CENTER
Practice Address - Street 2:1105 SIXTH STREET
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314888367500000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WP0200XNursing Service ProvidersRegistered NursePediatrics