Provider Demographics
NPI:1821162728
Name:REYNOLDS, DEBORAH JEAN (ANP ACNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:ANP ACNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:BEEVOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN ANP ACNP
Mailing Address - Street 1:1755 COBURG RD UNIT 401
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4984
Mailing Address - Country:US
Mailing Address - Phone:541-255-3905
Mailing Address - Fax:541-255-3959
Practice Address - Street 1:1755 COBURG RD UNIT 401
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4984
Practice Address - Country:US
Practice Address - Phone:541-255-3905
Practice Address - Fax:541-255-3959
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00032996NO363LA2100X
OR200150050NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
137345Medicare PIN
ORQ78491Medicare UPIN
ORR137345Medicare PIN