Provider Demographics
NPI:1861461550
Name:REID, TERI MARLA FRIEDMAN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:MARLA FRIEDMAN
Last Name:REID
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-0416
Mailing Address - Country:US
Mailing Address - Phone:252-745-2070
Mailing Address - Fax:252-745-2202
Practice Address - Street 1:313 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515-2851
Practice Address - Country:US
Practice Address - Phone:252-745-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300091363LP0200X
NC9600080363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004781Medicaid