Provider Demographics
NPI:1780898874
Name:REYNOLDS, ELLEN MARY (RN)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11002 W LAURELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-4036
Mailing Address - Country:US
Mailing Address - Phone:623-772-2580
Mailing Address - Fax:
Practice Address - Street 1:11002 W LAURELWOOD LN
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-4036
Practice Address - Country:US
Practice Address - Phone:623-772-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN097355163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool