Provider Demographics
NPI:1134498082
Name:REED - DAVIS, FREDDIE (APN-CNP)
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:
Last Name:REED - DAVIS
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:MRS
Other - First Name:FREDDIE
Other - Middle Name:
Other - Last Name:REED- DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6820
Mailing Address - Fax:414-266-6979
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6820
Practice Address - Fax:414-266-6979
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003969363LN0005X
WI5182363LN0005X
TX1016323363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1134498082Medicaid