Provider Demographics
NPI:1558179564
Name:REYNOLDS, KAREN GREENE (DHA, BCPA, CPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:GREENE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DHA, BCPA, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24183
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-4183
Mailing Address - Country:US
Mailing Address - Phone:877-745-7452
Mailing Address - Fax:888-288-5304
Practice Address - Street 1:103 ECORSE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5743
Practice Address - Country:US
Practice Address - Phone:877-745-7452
Practice Address - Fax:888-288-5304
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator