Healthcare Provider Details

I. General information

NPI: 1184924078
Provider Name (Legal Business Name): KATHLEEN RAE REED RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 H STREET
POPLAR MT
59255
US

IV. Provider business mailing address

815 5TH AVENUE NORTH
WOLF POINT MT
59201
US

V. Phone/Fax

Practice location:
  • Phone: 406-768-3491
  • Fax:
Mailing address:
  • Phone: 406-650-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28457
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: