Provider Demographics
NPI:1477874279
Name:REYNOLDS, STACY LYNETTE
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNETTE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 EVA LANE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1016
Mailing Address - Country:US
Mailing Address - Phone:513-659-9093
Mailing Address - Fax:
Practice Address - Street 1:4510 EVA LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1016
Practice Address - Country:US
Practice Address - Phone:513-659-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH344359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse