Provider Demographics
NPI:1083632848
Name:REYNOLDS, VICKI S (NP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:S
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:5 TOLL
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:215-481-4200
Mailing Address - Fax:215-481-9587
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:5 TOLL
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-4200
Practice Address - Fax:215-481-9587
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006712U363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098294Medicare PIN