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General NPI Number Information
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NPI Number | 1437031986
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Entity Type | Individual
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Provider Name | ELISA REYNOLDS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 3501 PALMER DR STE 201
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City | CAMERON PARK
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State | CA
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Zip | 95682-8276
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Country | US
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Telephone | 530-672-7040
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Fax |
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Provider Business Mailing Address
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Address Line | 602 KORU ST
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-5316
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Country | US
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Telephone | 530-414-1564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95036332
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License Number State | CA
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