Provider Demographics
NPI:1235103292
Name:REYNOLDS, MARCIA VELEET (FNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:VELEET
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PENNS WAY
Mailing Address - Street 2:SUITE 412
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720
Mailing Address - Country:US
Mailing Address - Phone:302-652-2455
Mailing Address - Fax:302-322-6251
Practice Address - Street 1:27 MARROWS ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-652-2455
Practice Address - Fax:302-322-6251
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000326363LF0000X
DELG-0000350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELG-0000350OtherSTATE LICENSE
DEL1-0002413OtherRN LICENSE