Individual
KATHY DIANE REID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC
Contact information
Practice address
1000 PAVILLIONS CIR, TRAVERSE CITY, MI 49684-3198
(231) 932-3801
(231) 421-3789
Mailing address
10850 E TRAVERSE HWY, TRAVERSE CITY, MI 49684-1364
(231) 346-6930
(231) 346-6017
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4704133106
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4570969
—
MI
Enumeration date
08/11/2005
Last updated
10/28/2015
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