Provider Demographics
NPI:1093901274
Name:REID, DEBORAH M (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:M
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 1:312 PARK ROW
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1550
Mailing Address - Country:US
Mailing Address - Phone:410-990-1202
Mailing Address - Fax:410-990-1203
Practice Address - Street 1:312 PARK ROW
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1550
Practice Address - Country:US
Practice Address - Phone:410-990-1202
Practice Address - Fax:410-990-1203
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN280341363LF0000X
WV79411363LF0000X
VA0024169074363LF0000X
MDR213017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ970500Medicaid
AZ8HE544OtherMEDICARE PART B - CHINLE
AZ8HE545OtherMEDICARE PART B - PINON
AZ8HE546OtherMEDICARE PART B - TSAILE
AZ8HE545OtherMEDICARE PART B - PINON