Healthcare Provider Details

I. General information

NPI: 1154613941
Provider Name (Legal Business Name): RENEE REED MSN,RN,ANP-C,GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11385 SW NOVA CT
TIGARD OR
97223-3922
US

IV. Provider business mailing address

13120 SW HEATHER CT
BEAVERTON OR
97008-5612
US

V. Phone/Fax

Practice location:
  • Phone: 503-780-3708
  • Fax: 503-639-3870
Mailing address:
  • Phone: 503-780-3708
  • Fax: 503-639-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number096000646
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201250059NP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number201250059
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: