Provider Demographics
NPI:1811055619
Name:REYNOLDS, ROBYN I (PAC)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:I
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 LAPEER
Mailing Address - Street 2:HEALTH DELIVERY INC
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:501 LAPEER
Practice Address - Street 2:HEALTH DELIVERY INC
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1208
Practice Address - Country:US
Practice Address - Phone:989-759-6464
Practice Address - Fax:989-399-8233
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381908328-376OtherCOMMUNITY CHOICE OF MICHIGAN/CXARE SOURCE
MI158607OtherGREALT LAKES HEALTH OF MICHIGAN
MI381908328-374OtherCOMMUNITY CHOICE OF MICHIGAN/CARESOURCE
MI381908328-375OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI468660OtherMOLINA HEALTHCARE
MI381908328-379OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI381908328OtherTRICARE
MI381908328-380OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURE
MI381908328-377OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI381908328-378OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI381908328-381OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE
MI381908328-374OtherCOMMUNITY CHOICE OF MICHIGAN/CARESOURCE
MI381908328-377OtherCOMMUNITY CHOICE OF MICHIGAN/CARE SOURCE