Provider Demographics
NPI:1962825877
Name:REYNOLDS, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
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 1:900 STEVENS DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3535
Mailing Address - Country:US
Mailing Address - Phone:509-946-7900
Mailing Address - Fax:509-946-7944
Practice Address - Street 1:900 STEVENS DR
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3535
Practice Address - Country:US
Practice Address - Phone:509-946-7900
Practice Address - Fax:509-946-7944
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN360443652367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife