=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669008843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLEGRA REYNOLDS HCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2020
-----------------------------------------------------
Last Update Date | 03/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21630 84TH AVE W
-----------------------------------------------------
City | EDMUNDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-218-9685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 6213 P.O. BOX 257
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-218-9685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------