Provider Demographics
NPI:1265165005
Name:REED, JENNIFER (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REED
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 1:22601 HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:NEW WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47162-9137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22601 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:NEW WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47162-9137
Practice Address - Country:US
Practice Address - Phone:502-551-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN281A66546163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1003563834Medicaid