MEDICARE: CLAIRE REYNOLDS

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	163W00000X	Registered Nurse	4704333366	MI

General Provider Information

NPI Number	:	1558256701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE REYNOLDS

Provider Business Mailing Address
First Line	:	6619 RIDGEFIELD CIR APT 205
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3044
Country	:	US
Telephone Number	:	248-756-1648
Fax Number	:

Provider Business Practice Location Address
First Line	:	6619 RIDGEFIELD CIR APT 205
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3044
Country	:	US
Telephone Number	:	248-756-1648
Fax Number	:

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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