Provider Demographics
NPI:1356553580
Name:REYNOLDS, REBECCA LOUISE
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LOUISE
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 1:3225 MANZANITA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287
Mailing Address - Country:US
Mailing Address - Phone:419-945-2318
Mailing Address - Fax:419-945-2318
Practice Address - Street 1:3225 MANZANITA DRIVE
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287
Practice Address - Country:US
Practice Address - Phone:419-945-2318
Practice Address - Fax:419-945-2318
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN099497164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse