MEDICARE: HALI JO REID 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	363LF0000X	Family Nurse Practitioner	F350653-01	NY

General Provider Information

NPI Number	:	1942910674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALI JO REID NP

Provider Business Mailing Address
First Line	:	20053 SUMMIT VIEW BLVD STE 1
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-2170
Country	:	US
Telephone Number	:	315-755-2560
Fax Number	:	315-257-6610

Provider Business Practice Location Address
First Line	:	20053 SUMMIT VIEW BLVD STE 1
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-2170
Country	:	US
Telephone Number	:	315-755-2560
Fax Number	:	315-257-6610

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/15/2025

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