Healthcare Provider Details

I. General information

NPI: 1013790492
Provider Name (Legal Business Name): DESIRAE EUNIQUE REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9614 UNIVERSITY AVE APT 106L
CEDAR FALLS IA
50613-9113
US

IV. Provider business mailing address

9616 UNIVERSITY AVE APT 106L
CEDAR FALLS IA
50613
US

V. Phone/Fax

Practice location:
  • Phone: 316-550-8210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: