Provider Demographics
NPI:1295924074
Name:REYNOLDS, CARMEN L (RN, BSN)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N PLUMER AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5906
Mailing Address - Country:US
Mailing Address - Phone:520-225-4317
Mailing Address - Fax:520-225-4515
Practice Address - Street 1:102 N PLUMER AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5906
Practice Address - Country:US
Practice Address - Phone:520-225-4317
Practice Address - Fax:520-225-4515
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 036682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN 036682OtherRN