Healthcare Provider Details

I. General information

NPI: 1578095345
Provider Name (Legal Business Name): ERIN REYNOLDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 EDGEWATER DR
COLUMBIA SC
29223-6136
US

IV. Provider business mailing address

7530 EDGEWATER DR
COLUMBIA SC
29223-6136
US

V. Phone/Fax

Practice location:
  • Phone: 803-719-7876
  • Fax:
Mailing address:
  • Phone: 803-719-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN267256
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number90915
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: