Provider Demographics
NPI:1649901794
Name:REYNOLDS, ASHLEY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1215 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-6156
Mailing Address - Country:US
Mailing Address - Phone:520-250-5269
Mailing Address - Fax:
Practice Address - Street 1:350 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2602
Practice Address - Country:US
Practice Address - Phone:520-873-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ206504163W00000X
AZL-301844163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse