Provider Demographics
NPI:1114022233
Name:REEDY, MARIE J (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:J
Last Name:REEDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:J
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:SUITE 502
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:877-515-0053
Practice Address - Fax:916-454-6926
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA185771Medicare PIN