Provider Demographics
NPI:1831596139
Name:REYNDERS, LUANN
Entity type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:REYNDERS
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 1:5127 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1345
Mailing Address - Country:US
Mailing Address - Phone:517-541-6449
Mailing Address - Fax:
Practice Address - Street 1:5127 TWIN LAKES DR
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1345
Practice Address - Country:US
Practice Address - Phone:517-541-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703078194164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse