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General NPI Number Information
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NPI Number | 1962914366
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Entity Type | Individual
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Provider Name | ISHARON BENYETTE REYNOLDS NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 2111 WOODWARD AVE STE 1200
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City | DETROIT
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State | MI
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Zip | 48201-3415
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Country | US
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Telephone | 313-488-4332
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Fax | 313-488-4332
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Provider Business Mailing Address
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Address Line | 3100 S GREYFRIAR ST
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City | DETROIT
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State | MI
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Zip | 48217-1072
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Country | US
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Telephone | 313-629-9330
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704361588
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.023310
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License Number State | OH
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