Provider Demographics
NPI:1609600568
Name:REED, NICHOLAS B (NP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:B
Last Name:REED
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 N 22ND AVE W
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1243
Mailing Address - Country:US
Mailing Address - Phone:218-464-8793
Mailing Address - Fax:
Practice Address - Street 1:1016 N 22ND AVE W
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1243
Practice Address - Country:US
Practice Address - Phone:218-464-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner