Doctor Name: | MELISSA JO REYNOLDS |
NPI Number: | 1063724151 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 28189519A |
Business Practice Address: | 1015 Michigan Ave Logansport, IN - 469471526 |
Business Phone Number: | 5747225151 |
Business Fax Number: | 5747391313 |
Mailing Address: | 1015 Michigan Ave, LOGANSPORT |
State: | IN |
Postal Code: | 469471526 |
Phone Number: | 5747225151 |
Fax Number: | 5747391414 |
NPI Enumeration Date: | 07/06/2010 |
NPI Last Update Date: | 07/06/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0809X |
License Number: | 28189519A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health, Adult |
Taxonomy Definition: |