Provider Demographics
NPI:1710377874
Name:REYNOLDS, JAYMEE LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JAYMEE
Middle Name:LEE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 CHAMPION ST APT 208
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-3364
Mailing Address - Country:US
Mailing Address - Phone:315-681-0809
Mailing Address - Fax:
Practice Address - Street 1:258 CHAMPION ST APT 208
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-3364
Practice Address - Country:US
Practice Address - Phone:315-681-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10319629164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse