Provider Demographics
NPI:1700049384
Name:REEL, DEETTE CONGLETON (CNM)
Entity Type:Individual
Prefix:
First Name:DEETTE
Middle Name:CONGLETON
Last Name:REEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7201
Mailing Address - Country:US
Mailing Address - Phone:252-758-4181
Mailing Address - Fax:252-758-2603
Practice Address - Street 1:101 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7201
Practice Address - Country:US
Practice Address - Phone:252-758-4181
Practice Address - Fax:252-758-2603
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC420367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife