Healthcare Provider Details

I. General information

NPI: 1700683406
Provider Name (Legal Business Name): MAURICE EDWARD REYNOLDS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FOUNDERS ST STE 100
WILLIMANTIC CT
06226-2049
US

IV. Provider business mailing address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-423-9764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14517
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: