Provider Demographics
NPI:1255149605
Name:REYNOLDS, JULIE M
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:NIOBRARA
Mailing Address - State:NE
Mailing Address - Zip Code:68760-0041
Mailing Address - Country:US
Mailing Address - Phone:402-640-5781
Mailing Address - Fax:
Practice Address - Street 1:101 SYCAMORE CIR
Practice Address - Street 2:
Practice Address - City:NIOBRARA
Practice Address - State:NE
Practice Address - Zip Code:68760-6106
Practice Address - Country:US
Practice Address - Phone:402-640-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider