Provider Demographics
NPI:1619198983
Name:DIANE E. REED
Entity Type:Organization
Organization Name:DIANE E. REED
Other - Org Name:MACDONALD HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MSN FNP
Authorized Official - Phone:607-458-5158
Mailing Address - Street 1:1585 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:WOODHULL
Mailing Address - State:NY
Mailing Address - Zip Code:14898-9600
Mailing Address - Country:US
Mailing Address - Phone:607-458-5158
Mailing Address - Fax:607-458-5598
Practice Address - Street 1:1585 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WOODHULL
Practice Address - State:NY
Practice Address - Zip Code:14898-9600
Practice Address - Country:US
Practice Address - Phone:607-458-5158
Practice Address - Fax:607-458-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1126Medicare ID - Type Unspecified