MEDICARE: LAUREN ASHLEY REYNOLDS H.I.S

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	237700000X	Hearing Instrument Specialist	3501009184	MI

General Provider Information

NPI Number	:	1497399166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ASHLEY REYNOLDS H.I.S

Provider Business Mailing Address
First Line	:	1000 3 MILE RD NW OFC D
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49544-1650
Country	:	US
Telephone Number	:	616-538-5300
Fax Number	:	616-538-5006

Provider Business Practice Location Address
First Line	:	38 44TH ST SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2177
Country	:	US
Telephone Number	:	616-457-6100
Fax Number	:	616-457-6101

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

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2019

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