Provider Demographics
NPI:1497260954
Name:REED, ROSIELEETTA
Entity Type:Individual
Prefix:
First Name:ROSIELEETTA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 RETTA MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4111
Mailing Address - Country:US
Mailing Address - Phone:214-980-6138
Mailing Address - Fax:888-617-5238
Practice Address - Street 1:7605 RETTA MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4111
Practice Address - Country:US
Practice Address - Phone:214-980-6138
Practice Address - Fax:888-617-5238
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12757489347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle