Provider Demographics
NPI:1114907672
Name:REID, DIANA (APNC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5969
Mailing Address - Country:US
Mailing Address - Phone:732-262-1431
Mailing Address - Fax:
Practice Address - Street 1:1130 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8345
Practice Address - Country:US
Practice Address - Phone:732-244-6380
Practice Address - Fax:732-244-6420
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN98623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner