Provider Demographics
NPI:1689764193
Name:REED, MARY CONWALL (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CONWALL
Last Name:REED
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 PEPPERELL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5452
Mailing Address - Country:US
Mailing Address - Phone:334-528-5808
Mailing Address - Fax:334-528-2161
Practice Address - Street 1:2000 WAVERLY PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4739
Practice Address - Country:US
Practice Address - Phone:334-528-5808
Practice Address - Fax:334-528-2161
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024151541367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007790686 541581185Medicaid
VA007790686 541581185Medicaid
420000037 C03686Medicare ID - Type Unspecified