Provider Demographics
NPI:1326700931
Name:REEDER, JALITA RENE (RN)
Entity Type:Individual
Prefix:
First Name:JALITA
Middle Name:RENE
Last Name:REEDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15066 WARRIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-6561
Mailing Address - Country:US
Mailing Address - Phone:360-770-4714
Mailing Address - Fax:
Practice Address - Street 1:15066 WARRIOR AVE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-6561
Practice Address - Country:US
Practice Address - Phone:360-770-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2483654163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency