Provider Demographics
NPI:1912418567
Name:REID, ANGELA SANDRA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SANDRA
Last Name:REID
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:SANDRA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2706 225TH LN NW
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-9317
Mailing Address - Country:US
Mailing Address - Phone:763-360-9112
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-21
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR153636-3163WN0002X
MN5551363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive CareGroup - Single Specialty