Doctor Name: | MRS. AMY LYNN REYNOLDS |
NPI Number: | 1063650455 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. - C. |
License Number: | 309004087 |
Business Practice Address: | 211 E Hanover St New Baden, IL - 622651811 |
Business Phone Number: | 6185882900 |
Business Fax Number: | 6185882904 |
Mailing Address: | 211 E Hanover St, NEW BADEN |
State: | IL |
Postal Code: | 622651811 |
Phone Number: | 6185882900 |
Fax Number: | 6185882904 |
NPI Enumeration Date: | 01/23/2009 |
NPI Last Update Date: | 12/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 309004087 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |