MEDICARE: NETESHA REID NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN50698	RI
2	363LF0000X	Family Nurse Practitioner	APRN02038	RI

General Provider Information

NPI Number	:	1033514971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NETESHA REID NP

Provider Business Mailing Address
First Line	:	1830 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3864
Country	:	US
Telephone Number	:	401-351-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3864
Country	:	US
Telephone Number	:	401-351-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	05/01/2019

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