Provider Demographics
NPI:1285865790
Name:REID, CARMEN L (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:REID
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 FALLEN TIMBERS LN
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9359
Mailing Address - Country:US
Mailing Address - Phone:419-887-5742
Mailing Address - Fax:
Practice Address - Street 1:6055 FALLEN TIMBERS LN
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9359
Practice Address - Country:US
Practice Address - Phone:419-887-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.345771163W00000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical