Provider Demographics
NPI:1801761283
Name:REYNOLDS, MICHELLE MARIE (RN, BSN, HNB-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN, BSN, HNB-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2118 S CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1831
Mailing Address - Country:US
Mailing Address - Phone:248-319-6135
Mailing Address - Fax:248-567-6858
Practice Address - Street 1:1961 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0246
Practice Address - Country:US
Practice Address - Phone:248-319-6135
Practice Address - Fax:248-567-6858
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704262407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse