Provider Demographics
NPI:1164424792
Name:REYNOLDS, LYNNOVA J (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNNOVA
Middle Name:J
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2209 JOHN R WOODEN DR
Practice Address - Street 2:WOMAN TO WOMAN
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1840
Practice Address - Country:US
Practice Address - Phone:765-352-9536
Practice Address - Fax:765-349-6433
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001906A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200450030Medicaid
IN090540035Medicare PIN
ING34916Medicare UPIN
IN1104827633OtherGROUP NPI NUMBER
IN191430BMedicare ID - Type UnspecifiedM-CARE INDIVIDUAL NUMBER
IN200377200Medicaid