Provider Demographics
NPI:1134182298
Name:REYNOLDS, NANCY (FNP-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 S CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2608
Mailing Address - Country:US
Mailing Address - Phone:585-473-2846
Mailing Address - Fax:585-473-3098
Practice Address - Street 1:1820 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2608
Practice Address - Country:US
Practice Address - Phone:585-473-2846
Practice Address - Fax:585-473-3098
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330616363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB1904Medicare PIN
NYS61231Medicare UPIN