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NPI Code Detail

MEDICARE: BRIDGET S. REYNOLDS BSN, RN

MEDICARE: BRIDGET S. REYNOLDS BSN, RN
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 NurseRN095352AZ

General Provider Information

NPI Number : 1861510323
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET S. REYNOLDS BSN, RN
Provider Business Mailing Address
First Line : 7121 W LA SENDA DR
Second Line :
City : GLENDALE
State : AZ
Zip : 85310-5685
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 25250 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85083-4335
Country : US
Telephone Number : 623-445-7110
Fax Number : 623-445-7181
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 10/18/2007

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