Provider Demographics
NPI:1134147424
Name:REED, DIANNE JEAN (RNAPNC)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:JEAN
Last Name:REED
Suffix:
Gender:F
Credentials:RNAPNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 EDGEBROOK DR N
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-4523
Mailing Address - Country:US
Mailing Address - Phone:732-736-9020
Mailing Address - Fax:
Practice Address - Street 1:970 RT.70
Practice Address - Street 2:DEPT.VETERNS AFFAIRS JAMES J. HOWARD OUTPATIENT CLINIC
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-836-6003
Practice Address - Fax:732-836-6002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04169800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7511001Medicaid
NJ7511001Medicaid