Provider Demographics
NPI:1295868974
Name:REYNOLDS, LISA E
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
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 1:100 BLYTHEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4828
Mailing Address - Country:US
Mailing Address - Phone:931-381-5757
Mailing Address - Fax:
Practice Address - Street 1:100 BLYTHEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4828
Practice Address - Country:US
Practice Address - Phone:931-381-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide