Provider Demographics
NPI:1346875648
Name:REYNOLDS, CHRISTINA MARIE (CPM, LM, IBCLC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CPM, LM, IBCLC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:WOODLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM, LM, IBCLC
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-0402
Mailing Address - Country:US
Mailing Address - Phone:715-445-2277
Mailing Address - Fax:866-933-1286
Practice Address - Street 1:308 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945
Practice Address - Country:US
Practice Address - Phone:715-445-2277
Practice Address - Fax:866-933-1286
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316306459OtherNPPES
WI1942419394OtherNPPES