Provider Demographics
NPI:1609029875
Name:REYNOLDS, KATHLEEN A (RN CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
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Mailing Address - Street 1:2100 PFINGSTEN RD
Mailing Address - Street 2:3NORTH
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1301
Mailing Address - Country:US
Mailing Address - Phone:847-832-6118
Mailing Address - Fax:847-657-1660
Practice Address - Street 1:2100 PFINGSTEN RD
Practice Address - Street 2:3NORTH
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1301
Practice Address - Country:US
Practice Address - Phone:847-832-6118
Practice Address - Fax:847-657-1660
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041183517163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator