Basic Information
| Provider Information | |||||||||
| NPI: | 1538411475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEDER | ||||||||
| FirstName: | MARY CAROL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 SANTA FE DR | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606324269 | ||||||||
| FaxNumber: | 7606324256 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 SANTA FE DR | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606324269 | ||||||||
| FaxNumber: | 7606324256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
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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 | 363LA2100X | NP21978 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.