| Doctor Name: | SHAWNA MARIE REYNOLDS |
| NPI Number: | 1023260783 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | PA-778 |
| Business Practice Address: | 1441 Parkway Dr Blackfoot, ID - 832210000 |
| Business Phone Number: | 2087852600 |
| Business Fax Number: | 2087851762 |
| Mailing Address: | 1441 Parkway Dr, BLACKFOOT |
| State: | ID |
| Postal Code: | 832210000 |
| Phone Number: | 2087852600 |
| Fax Number: | 2082340026 |
| NPI Enumeration Date: | 10/14/2008 |
| NPI Last Update Date: | 04/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA-778 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |