Provider Demographics
NPI:1124321757
Name:REID, PATTY J (RN)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:J
Last Name:REID
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 1:151 S UNIVERSITY AVE
Mailing Address - Street 2:#1900
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4427
Mailing Address - Country:US
Mailing Address - Phone:801-851-7042
Mailing Address - Fax:801-851-7063
Practice Address - Street 1:151 S UNIVERSITY AVE
Practice Address - Street 2:#1900
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4427
Practice Address - Country:US
Practice Address - Phone:801-851-7042
Practice Address - Fax:801-851-7063
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2176113102174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT004444001Medicare PIN
UTX12342Medicare UPIN