Healthcare Provider Details

I. General information

NPI: 1164852786
Provider Name (Legal Business Name): ILA EVETTE REED NNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD
LOS ALAMOS NM
87544-2275
US

IV. Provider business mailing address

1980 KETTNER BLVD APT 331
SAN DIEGO CA
92101-2258
US

V. Phone/Fax

Practice location:
  • Phone: 505-353-2375
  • Fax:
Mailing address:
  • Phone: 505-353-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01036
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number95005675
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberCNP01036
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: