Provider Demographics
NPI:1558141366
Name:REID, SOMER MACKENIZE
Entity Type:Individual
Prefix:MISS
First Name:SOMER
Middle Name:MACKENIZE
Last Name:REID
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 1:55234 NORTHSTAR RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43772-9727
Mailing Address - Country:US
Mailing Address - Phone:740-995-9858
Mailing Address - Fax:
Practice Address - Street 1:12835 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-9782
Practice Address - Country:US
Practice Address - Phone:740-995-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy