Individual
JOHNATHAN BRETT REDDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, CNP
Contact information
Practice address
1123 N CHURCH ST, GREENSBORO, NC 27401-1007
(336) 832-4400
Mailing address
PO BOX 735044, CHICAGO, IL 60673
(262) 251-7500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
101031-875
WI
363L00000X
Nurse Practitioner
209023782
IL
363LF0000X
Family Nurse Practitioner
Primary
5021066
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100250920
—
WI
Enumeration date
03/14/2022
Last updated
10/30/2024
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