Healthcare Provider Details

I. General information

NPI: 1447206479
Provider Name (Legal Business Name): SHERRI LYNN REYNOLDS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5523 WALL ST
MEBANE NC
27302-8515
US

IV. Provider business mailing address

860 CRAIGMONT LN NW
CONCORD NC
28027-6442
US

V. Phone/Fax

Practice location:
  • Phone: 704-789-3059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: