Provider Demographics
NPI:1922429844
Name:CARRIE, REYNARD JR
Entity Type:Individual
Prefix:
First Name:REYNARD
Middle Name:
Last Name:CARRIE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 NE 121ST AVE UNIT 114
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6246
Mailing Address - Country:US
Mailing Address - Phone:360-944-4554
Mailing Address - Fax:360-256-3349
Practice Address - Street 1:5305 NE 121ST AVE UNIT 114
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-6246
Practice Address - Country:US
Practice Address - Phone:360-944-4554
Practice Address - Fax:360-256-3349
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA57181600174400000X
WA491380990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist