MEDICARE: DOUGLAS S REED NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	71011219A	IN

General Provider Information

NPI Number	:	1174192421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS S REED NP

Provider Business Mailing Address
First Line	:	208 E JEFFERSON ST
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-1710
Country	:	US
Telephone Number	:	260-229-0397
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 E DUPONT RD STE 108
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1601
Country	:	US
Telephone Number	:	260-432-2297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/22/2021

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Directions to “ DOUGLAS S REED NP” Practice Location

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