Provider Demographics
NPI:1063843043
Name:REYNOLDS, MARCIA
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 KENROY TER
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-6048
Mailing Address - Country:US
Mailing Address - Phone:509-884-5544
Mailing Address - Fax:509-886-8531
Practice Address - Street 1:860 KENROY TER
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-6048
Practice Address - Country:US
Practice Address - Phone:509-884-5544
Practice Address - Fax:509-886-8531
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00061479163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse