Provider Demographics
NPI:1396138541
Name:REED, TERRANCE DUANE (NP-C)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:DUANE
Last Name:REED
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1465 DELANCY CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-8501
Mailing Address - Country:US
Mailing Address - Phone:734-968-5265
Mailing Address - Fax:734-495-0892
Practice Address - Street 1:1465 DELANCY CIR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-8501
Practice Address - Country:US
Practice Address - Phone:734-968-5265
Practice Address - Fax:734-495-0892
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190400363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology