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NPI Code Detail

MEDICARE: TINA S. REYNOLDS L.P.N.

MEDICARE: TINA S. REYNOLDS L.P.N.
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
1164W00000XLicensed Practical NurseLPN0000032226TN

General Provider Information

NPI Number : 1528185188
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA S. REYNOLDS L.P.N.
Provider Business Mailing Address
First Line : 4744 PINE VIEW LN
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37416-1939
Country : US
Telephone Number : 423-893-1902
Fax Number :
Provider Business Practice Location Address
First Line : 9527 W RIDGE TRAIL RD
Second Line :
City : SODDY DAISY
State : TN
Zip : 37379-4018
Country : US
Telephone Number : 423-842-3031
Fax Number : 423-842-5353
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 07/08/2007

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