MEDICARE: EMY REID FNP

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	363L00000X	Nurse Practitioner	284471	CA

General Provider Information

NPI Number	:	1326141623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMY REID FNP

Provider Business Mailing Address
First Line	:	14623 KILLION ST
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-3734
Country	:	US
Telephone Number	:	818-781-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	14623 KILLION ST
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-3734
Country	:	US
Telephone Number	:	818-781-5472
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/30/2007

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