Provider Demographics
NPI:1447389317
Name:REYNOLDS, EVELYN DALE (RN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:DALE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 PICKWICK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-5309
Mailing Address - Country:US
Mailing Address - Phone:731-925-2557
Mailing Address - Fax:731-925-3100
Practice Address - Street 1:1920 PICKWICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-5309
Practice Address - Country:US
Practice Address - Phone:731-925-2557
Practice Address - Fax:731-925-3100
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000116088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse