Provider Demographics
NPI:1831882646
Name:REYNOLDS, MELISSA A (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 N BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3520
Mailing Address - Country:US
Mailing Address - Phone:248-225-8435
Mailing Address - Fax:
Practice Address - Street 1:3129 N BLAIR AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3520
Practice Address - Country:US
Practice Address - Phone:248-225-8435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program