Provider Demographics
NPI:1740736594
Name:REYNOLDS, LINDA DIANE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
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 1:10611 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-7807
Mailing Address - Country:US
Mailing Address - Phone:918-798-6502
Mailing Address - Fax:
Practice Address - Street 1:10611 E 30TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-7807
Practice Address - Country:US
Practice Address - Phone:918-798-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator