Provider Demographics
NPI:1033668199
Name:REYNOLDS, EMILY (CPM, LM)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 FLAMINGO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2245
Mailing Address - Country:US
Mailing Address - Phone:915-267-5166
Mailing Address - Fax:
Practice Address - Street 1:4153 FLAMINGO BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2245
Practice Address - Country:US
Practice Address - Phone:915-267-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99274176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife