Provider Demographics
NPI:1013238633
Name:REID, MARY DOROTHY (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DOROTHY
Last Name:REID
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FORD ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2360
Mailing Address - Country:US
Mailing Address - Phone:315-638-6123
Mailing Address - Fax:315-638-6170
Practice Address - Street 1:14 FORD ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2360
Practice Address - Country:US
Practice Address - Phone:315-638-6123
Practice Address - Fax:315-638-6170
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY367041-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool