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General NPI Number Information
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NPI Number | 1508344730
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Entity Type | Individual
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Provider Name | ANDREA REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 1550 OLD HENDERSON RD
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City | COLUMBUS
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State | OH
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Zip | 43220-3626
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Country | US
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Telephone | 614-456-7334
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 LOOKOUT LN
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City | PICKERINGTON
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State | OH
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Zip | 43147-9839
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Country | US
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Telephone | 121-646-9020
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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