Provider Demographics
NPI:1497357255
Name:REYNOLDS, MIKAELA RENEE (WHCNP-BC)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:RENEE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:WHCNP-BC
Other - Prefix:
Other - First Name:MIKAELA
Other - Middle Name:
Other - Last Name:SANDORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:818 5TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1307
Mailing Address - Country:US
Mailing Address - Phone:877-811-7526
Mailing Address - Fax:515-280-9525
Practice Address - Street 1:3105 N 93RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4717
Practice Address - Country:US
Practice Address - Phone:877-811-7526
Practice Address - Fax:515-280-9525
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112193363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health