MEDICARE: ELIZABETH REYNOLDS APRN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	76809	KS

General Provider Information

NPI Number	:	1134509201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH REYNOLDS APRN-C

Provider Business Mailing Address
First Line	:	4119 WIMBLEDON CIR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-2012
Country	:	US
Telephone Number	:	785-331-6602
Fax Number	:	785-331-1799

Provider Business Practice Location Address
First Line	:	1220 BILTMORE DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-1995
Country	:	US
Telephone Number	:	785-505-2626
Fax Number	:	785-505-5333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	09/02/2021

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Directions to “ ELIZABETH REYNOLDS APRN-C” Practice Location

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