MEDICARE: DENISE L REYNOLDS RN, CSN

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	163WS0200X	School Registered Nurse	95169638	CA

General Provider Information

NPI Number	:	1568288116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE L REYNOLDS RN, CSN

Provider Business Mailing Address
First Line	:	6875 ATLANTA CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-3233
Country	:	US
Telephone Number	:	209-610-6082
Fax Number	:

Provider Business Practice Location Address
First Line	:	6875 ATLANTA CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-3233
Country	:	US
Telephone Number	:	209-610-6082
Fax Number	:

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

Provider Enumeration Date	:	11/27/2024
Last Update Date	:	11/27/2024

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