Provider Demographics
NPI:1932176062
Name:REDDICK, DENISE ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELIZABETH
Last Name:REDDICK
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 1:53 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2829
Mailing Address - Country:US
Mailing Address - Phone:860-536-6918
Mailing Address - Fax:
Practice Address - Street 1:2100 2ND ST SW
Practice Address - Street 2:534
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0002
Practice Address - Country:US
Practice Address - Phone:860-444-8402
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR34830163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care