Provider Demographics
NPI:1588160352
Name:REYNOLDS, LARISSA (RN)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 CHERRYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4314
Mailing Address - Country:US
Mailing Address - Phone:606-776-7518
Mailing Address - Fax:
Practice Address - Street 1:1256 CHERRYWOOD CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-4314
Practice Address - Country:US
Practice Address - Phone:606-776-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH423436163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health