Provider Demographics
NPI:1669008843
Name:REYNOLDS, ALLEGRA (HCA)
Entity type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 6213 P.O. BOX 257
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507
Mailing Address - Country:US
Mailing Address - Phone:206-218-9685
Mailing Address - Fax:
Practice Address - Street 1:21630 84TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMUNDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:206-218-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider