Healthcare Provider Details

I. General information

NPI: 1922773670
Provider Name (Legal Business Name): JENNIFER LAURA REYNOLDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 WALLACE SCHOOL RD
CHARLESTON SC
29407-4822
US

IV. Provider business mailing address

2769 RIVERTOWNE PKWY
MOUNT PLEASANT SC
29466-7633
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-1555
  • Fax:
Mailing address:
  • Phone: 443-510-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR183322
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: