Provider Demographics
NPI:1629597893
Name:REYNOLDS, ANJELENE
Entity Type:Individual
Prefix:
First Name:ANJELENE
Middle Name:
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 1:5415 DISTINCTION WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-8438
Mailing Address - Country:US
Mailing Address - Phone:928-350-8045
Mailing Address - Fax:928-350-8264
Practice Address - Street 1:5415 DISTINCTION WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8438
Practice Address - Country:US
Practice Address - Phone:928-350-8045
Practice Address - Fax:928-350-8264
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant