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NPI Code Detail

MEDICARE: MADISEN LILLEY REYNARD NP

MEDICARE: MADISEN LILLEY REYNARD NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse930448TX
2207Q00000XFamily Medicine Physician1151442TX

General Provider Information

NPI Number : 1174285449
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISEN LILLEY REYNARD NP
Provider Business Mailing Address
First Line : 615 W ROUND BUNCH RD
Second Line :
City : BRIDGE CITY
State : TX
Zip : 77611-2434
Country : US
Telephone Number : 409-735-7305
Fax Number : 888-972-9401
Provider Business Practice Location Address
First Line : 615 W ROUND BUNCH RD
Second Line :
City : BRIDGE CITY
State : TX
Zip : 77611-2434
Country : US
Telephone Number : 409-735-7305
Fax Number : 888-972-9401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2021
Last Update Date : 10/07/2024

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Directions to “ MADISEN LILLEY REYNARD NP” Practice Location

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