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General NPI Number Information
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NPI Number | 1568898518
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Entity Type | Individual
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Provider Name | MS. CHARLESIA D REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 4780 ARVILLE ST # B
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City | LAS VEGAS
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State | NV
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Zip | 89103-5402
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Country | US
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Telephone | 602-710-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 8355 W CROWN KING RD
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City | TOLLESON
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State | AZ
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Zip | 85353-3616
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Country | US
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Telephone | 602-710-7731
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 1000024286
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License Number State | AZ
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