Healthcare Provider Details

I. General information

NPI: 1073934378
Provider Name (Legal Business Name): BRENDA REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W ELY ST
ALLIANCE OH
44601-1704
US

IV. Provider business mailing address

144 W ELY ST
ALLIANCE OH
44601-1704
US

V. Phone/Fax

Practice location:
  • Phone: 234-564-4365
  • Fax:
Mailing address:
  • Phone: 234-564-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number501002880705
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: