Provider Demographics
NPI:1952510588
Name:REED, LISA MARIE (MHS, PAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:REED
Suffix:
Gender:F
Credentials:MHS, PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1568
Mailing Address - Country:US
Mailing Address - Phone:989-883-3800
Mailing Address - Fax:989-883-9131
Practice Address - Street 1:4497 SHEFFIELD PLACE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-894-8400
Practice Address - Fax:989-883-9131
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004920363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant