Provider Demographics
NPI:1790307940
Name:REID, GLORIA E (FNPC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:E
Last Name:REID
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 WILTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6138
Mailing Address - Country:US
Mailing Address - Phone:207-778-9531
Mailing Address - Fax:207-778-6535
Practice Address - Street 1:672 WILTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6138
Practice Address - Country:US
Practice Address - Phone:207-778-9531
Practice Address - Fax:207-778-6535
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner