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General NPI Number Information
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NPI Number | 1740821099
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Entity Type | Individual
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Provider Name | ROBERT DALE REYNOLDS JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 801 E WHEELER RD
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City | MOSES LAKE
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State | WA
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Zip | 98837-1820
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Country | US
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Telephone | 509-765-5606
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S PIONEER WAY STE F PMB 372
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City | MOSES LAKE
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State | WA
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Zip | 98837
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Country | US
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Telephone | 661-604-5180
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP61565233
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP143400
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 305696
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 7122459-3102
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License Number State | UT
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA95001216
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License Number State | CA
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