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General NPI Number Information
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NPI Number | 1306731203
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Entity Type | Individual
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Provider Name | ELLYN REID
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 1717 SHAFFER ST
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City | KALAMAZOO
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State | MI
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Zip | 49048-1647
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Country | US
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Telephone | 269-552-0014
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Fax | 269-552-0016
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone | 269-552-2823
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Fax | 269-552-2964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704351071
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License Number State | MI
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