Provider Demographics
NPI:1356300685
Name:REYNOLDS, REBECCA GAIL (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GAIL
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 1:502 N NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2217
Mailing Address - Country:US
Mailing Address - Phone:401-533-2790
Mailing Address - Fax:
Practice Address - Street 1:502 N NORWOOD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2217
Practice Address - Country:US
Practice Address - Phone:401-533-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024150644363LF0000X
DCRN64493363LF0000X
VA0121000767171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017478M58Medicare UPIN
VA017478M58Medicare UPIN