Provider Demographics
NPI:1962814830
Name:REYNOLDS, WENDY (RN, CLC, ANLC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN, CLC, ANLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1145
Mailing Address - Country:US
Mailing Address - Phone:814-715-2548
Mailing Address - Fax:
Practice Address - Street 1:218 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825
Practice Address - Country:US
Practice Address - Phone:814-715-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN582429163WL0100X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care