Provider Demographics
NPI:1164852786
Name:REED, ILA EVETTE (NNP-BC)
Entity type:Individual
Prefix:
First Name:ILA
Middle Name:EVETTE
Last Name:REED
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 KETTNER BLVD APT 331
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2258
Mailing Address - Country:US
Mailing Address - Phone:505-353-2375
Mailing Address - Fax:
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-353-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002037363LN0005X
FLARNP9377302363LN0005X
NMCNP01036363LN0005X
CA95005675363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151317AMedicaid
FL010949200Medicaid
GA003151317AMedicaid