Healthcare Provider Details

I. General information

NPI: 1336468206
Provider Name (Legal Business Name): MEGAN ELIZABETH REID NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066-4899
US

IV. Provider business mailing address

530A S MAIN ST
OCONOMOWOC WI
53066-3643
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-7354
  • Fax:
Mailing address:
  • Phone: 262-434-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number166122-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6278
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6278-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: