Provider Demographics
NPI:1992900989
Name:REED, LAURIE A (APRN, BC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:REED
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST ST.
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030
Mailing Address - Country:US
Mailing Address - Phone:440-593-6551
Mailing Address - Fax:440-593-6552
Practice Address - Street 1:117 WEST ST.
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030
Practice Address - Country:US
Practice Address - Phone:440-593-6551
Practice Address - Fax:440-593-6552
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA09445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000557159OtherANTHEM BLUE SHIELD
OH2803354Medicaid
OHNP24482Medicare PIN