Healthcare Provider Details

I. General information

NPI: 1417784158
Provider Name (Legal Business Name): ABIGAIL ELISE REYNOLDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

206 SARAH WAY
KIMBERLY AL
35091-3201
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-7310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1-198322
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: