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General NPI Number Information
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NPI Number | 1689462012
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Entity Type | Individual
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Provider Name | MS. PHOENIX DAWN REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 04/26/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 4141 N 156TH ST STE 2022
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City | OMAHA
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State | NE
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Zip | 68116-1440
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Country | US
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Telephone | 402-838-2321
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Fax | 402-702-0586
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Provider Business Mailing Address
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Address Line | 8340 SW 65TH AVE APT 7
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City | MIAMI
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State | FL
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Zip | 33143-7948
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Country | US
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Telephone | 786-521-5824
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11039061
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License Number State | FL
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