Provider Demographics
NPI:1356318083
Name:REESIDE, AMY CORINNE (FNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:CORINNE
Last Name:REESIDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:301 RANDOLPH STREET
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-0660
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:609 DAFFIN LANE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1392
Practice Address - Country:US
Practice Address - Phone:410-479-2650
Practice Address - Fax:410-479-1626
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR133336363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521116591OtherTRICARE
MD60958803OtherCAREFIRST BC/BS RENDERING
MD737190OtherNCPPO
MD012953OtherPRIORITY PARTNERS
MD6191265OtherCIGNA
MD521116591OtherCOVENTRY
MD521116591OtherINFORMED
MD784381000Medicaid
MDT5880026OtherCF BC/BS GRP/GHMSI/BL CHO
MD521116591OtherMARYLAND PHYSICIANS CARE
MD521116591OtherINFORMED
MD60958803OtherCAREFIRST BC/BS RENDERING