Provider Demographics
NPI:1760017040
Name:ST GERMAIN, REYNA (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:REYNA
Middle Name:
Last Name:ST GERMAIN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 MAPLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2410
Mailing Address - Country:US
Mailing Address - Phone:571-351-3332
Mailing Address - Fax:
Practice Address - Street 1:1469 MAPLE HILLS DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-2410
Practice Address - Country:US
Practice Address - Phone:571-351-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001218179163W00000X
VA0024179438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse