MEDICARE: MS. HEATHER DAWN REYNOLDS CNM, MSN, FACNM

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
1	367A00000X	Advanced Practice Midwife	000042	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538160221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER DAWN REYNOLDS CNM, MSN, FACNM

Provider Business Mailing Address
First Line	:	53 SEA ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-2813
Country	:	US
Telephone Number	:	203-777-3607
Fax Number	:	203-785-6655

Provider Business Practice Location Address
First Line	:	20 YORK ST
Second Line	:	WOMEN'S CENTER TMPB
City	:	NEW HAVEN
State	:	CT
Zip	:	06504-8900
Country	:	US
Telephone Number	:	203-688-4101
Fax Number	:	203-688-7274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/27/2013

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