Provider Demographics
NPI:1386938553
Name:REID, DINA JENE (CNP)
Entity type:Individual
Prefix:MS
First Name:DINA
Middle Name:JENE
Last Name:REID
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13512 TERRAGON DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6333
Mailing Address - Country:US
Mailing Address - Phone:505-379-8232
Mailing Address - Fax:505-503-1518
Practice Address - Street 1:13512 TERRAGON DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6333
Practice Address - Country:US
Practice Address - Phone:505-379-8232
Practice Address - Fax:505-503-1518
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR07910363LW0102X
NMCNP000025363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1386938553Medicaid