Basic Information
| Provider Information | |||||||||
| NPI: | 1356318083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REESIDE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | CORINNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 660 | ||||||||
| Address2: | 301 RANDOLPH STREET | ||||||||
| City: | DENTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216290660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104794306 | ||||||||
| FaxNumber: | 4104791714 | ||||||||
| Practice Location | |||||||||
| Address1: | 609 DAFFIN LANE | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216291392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104792650 | ||||||||
| FaxNumber: | 4104791626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 09/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R133336 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 521116591 | 01 | MD | TRICARE | OTHER | 60958803 | 01 | MD | CAREFIRST BC/BS RENDERING | OTHER | 737190 | 01 | MD | NCPPO | OTHER | 012953 | 01 | MD | PRIORITY PARTNERS | OTHER | 6191265 | 01 | MD | CIGNA | OTHER | 521116591 | 01 | MD | COVENTRY | OTHER | 521116591 | 01 | MD | INFORMED | OTHER | 784381000 | 05 | MD | MEDICAID | T5880026 | 01 | MD | CF BC/BS GRP/GHMSI/BL CHO | OTHER | 521116591 | 01 | MD | MARYLAND PHYSICIANS CARE | OTHER |