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General NPI Number Information
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NPI Number | 1437636511
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Entity Type | Individual
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Provider Name | LAURA JO REYNOLDS RN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 25 CHATEAU TER
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City | BUFFALO
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State | NY
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Zip | 14226-3927
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Country | US
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Telephone | 716-839-1655
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Fax |
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Provider Business Mailing Address
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Address Line | 7319 KINNE RD
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City | LOCKPORT
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State | NY
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Zip | 14094-9358
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Country | US
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Telephone | 716-523-5100
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 636782
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F352911-01
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License Number State | NY
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