Healthcare Provider Details

I. General information

NPI: 1942910674
Provider Name (Legal Business Name): HALI JO REID NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20053 SUMMIT VIEW BLVD STE 1
WATERTOWN NY
13601-2170
US

IV. Provider business mailing address

20053 SUMMIT VIEW BLVD STE 1
WATERTOWN NY
13601-2170
US

V. Phone/Fax

Practice location:
  • Phone: 315-755-2560
  • Fax: 315-257-6610
Mailing address:
  • Phone: 315-755-2560
  • Fax: 315-257-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350653-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: